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Tennessee rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.58 / $16.35 / $24.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.58 / $12.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.16 / $15.16 / $15.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.16 / $6.16 / $6.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $13.37