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Virginia rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $22.94 / $33.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.70 / $14.14 / $22.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.13
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.72 / $10.11 / $15.73
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.16 / $15.16 / $19.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $7.00 / $7.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.81 / $12.43 / $15.91
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $12.43 / $15.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.23 / $12.43 / $15.73