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Wisconsin rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $27.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $15.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.40 / $14.41 / $14.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.13 / $12.43 / $22.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.86 / $16.07 / $22.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.95 / $11.66 / $13.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.96 / $12.13 / $15.16
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.61 / $9.61 / $9.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $7.80 / $15.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $16.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.96 / $12.13 / $15.16
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.61 / $9.61 / $9.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.55 / $16.02 / $23.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.67 / $12.67 / $23.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $16.16