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Utah rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.58 / $12.58 / $12.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $12.58 / $12.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.39 / $13.29 / $19.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $12.43 / $12.43