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Texas rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $22 · 10th–90th $9–$490%5%10%10th90th$22Professionalmedian $14 · 10th–90th $12–$190%20%40%10th90th$14$10.0$20.0$50.0$100.0

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
$14.13 / $21.38 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $14.13 / $19.50
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.55 / $24.55 / $45.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $30.20 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $18.62 / $28.84
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $14.13 / $23.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $10.47 / $10.47
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.41 / $15.14 / $40.74
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.17 / $6.61 / $10.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $12.30