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Washington rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $30.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $12.89 / $12.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $9.86 / $19.07
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $10.05 / $15.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $14.94 / $26.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.85 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.39 / $11.20 / $16.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.67 / $13.64 / $15.16
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $9.44 / $14.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $10.05 / $10.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43