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Maine rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $38 · 10th–90th $8–$380%50%10th$38Professionalmedian $12 · 10th–90th $12–$130%50%90th$12$10.0$20.0

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
$35.48 / $38.02 / $38.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.31 / $7.59 / $20.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.88 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $14.45 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $15.49
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $21.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $12.88 / $18.20