APC 01689

Fomepizole antidote medication

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Fomepizole

Payers reporting APC 01689

Payer pricing summary

Low

Average

$144

Median

$10

High

$780

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +1 other terms	86	$6	$7	$1	18%	—	$5 – $10
2	Caresource fee schedule · outpatient	20	$6	$7	$2	21%	—	$6 – $10
3	Blue Cross Blue Shield fee schedule · outpatient · +1 other terms	11	$6	$8	$2	20%	—	$6 – $10
4	UnitedHealthcare facility · fee schedule · outpatient · +2 other terms	9	$7	$228	$316	139%	—	$6 – $773
5	Aetna facility · fee schedule · outpatient · +1 other terms	7	$6	$6	$0	3%	—	$6 – $7
6	Medicare facility · fee schedule · outpatient · +1 other terms	7	$6	$129	$245	190%	—	$6 – $618
7	Clover fee schedule · outpatient	5	$10	$10	—	—	—	$10 – $10
8	Kaiser fee schedule · outpatient · +1 other terms	5	$10	$10	—	—	—	$10 – $10
9	WellCare fee schedule · outpatient · +1 other terms	5	$10	$10	—	—	—	$10 – $10
10	Ambetter facility · fee schedule · outpatient	3	$1.1k	$766	$535	70%	—	$9 – $1.1k
11	Amerihealth Caritas facility · fee schedule · outpatient	3	$974	$781	$501	64%	—	$7 – $1.3k
12	Carefirst facility · fee schedule · outpatient	3	$6	$6	—	—	—	$6 – $6
13	Medica facility · fee schedule · outpatient	3	$7	$7	—	—	—	$7 – $7
14	Tricare facility · fee schedule · outpatient	3	$6	$6	—	—	—	$6 – $6
15	Cigna facility · fee schedule · outpatient	2	$618	$618	—	—	—	$618 – $618
16	Aetna Better Health facility · fee schedule · outpatient	1	$6	$6	—	—	—	$6 – $6
17	Devoted facility · fee schedule · outpatient	1	$7	$7	—	—	—	$7 – $7
18	Highmark facility · fee schedule · outpatient · +1 other terms	1	$6	$6	$0	7%	—	$6 – $7
19	Oscar facility · fee schedule · outpatient	1	$10	$10	—	—	—	$10 – $10