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West Virginia rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $15.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $12.89 / $12.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.86 / $6.05 / $10.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $19.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $18.00