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Vermont rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $21.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.01 / $25.01 / $31.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $12.43 / $19.12