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Pennsylvania rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $22 · 10th–90th $13–$2,2910%10%20%10th90th$22Professionalmedian $12 · 10th–90th $12–$150%50%90th$12$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$12.88 / $23.44 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.72 / $12.59 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $44.67 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $18.62 / $23.44
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $14.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.61 / $6.61 / $6.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.98