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Wisconsin rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $12 · 10th–90th $6–$190%20%40%10th90th$12Professionalmedian $12 · 10th–90th $11–$200%50%10th90th$12$5.0$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
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $14.13 / $14.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $12.30 / $22.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.91 / $16.98 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $12.02 / $13.49
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $12.02 / $15.14
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.55 / $9.55 / $9.55
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.03 / $7.76 / $15.14
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.22
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.46 / $6.46 / $12.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $16.60 / $24.55
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $23.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $14.45
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.98