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New Hampshire rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $17 · 10th–90th $10$330%10%10th90th$17Professionalmedian $13 · 10th–90th $12$240%20%10th90th$13$10.0$20.0$50.0

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
$12.88 / $14.45 / $16.22
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $12.02 / $12.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $23.44 / $45.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.88 / $14.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $27.54 / $35.48
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 / $21.38 / $24.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.23 / $10.23 / $10.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $12.30 / $19.50