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Illinois rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $25 · 10th–90th $12–$450%20%10th90th$25Professionalmedian $12 · 10th–90th $12–$180%50%90th$12$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $25.12 / $40.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $18.20
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.71 / $30.20 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $23.99 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.72 / $125.89 / $346.74
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $8.51 / $9.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.61 / $6.61 / $10.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $13.18