APC 1689

Fomepizole medication, poisoning antidote

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 1689

Payer pricing summary

Low

Average

$49

Median

High

$658

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +5 other terms	174	$7	$6	$0	2%	—	$6 – $7
2	Humana fee schedule · outpatient · +5 other terms	161	$6	$7	$2	28%	—	$6 – $26
3	Aetna fee schedule · outpatient · +4 other terms	155	$6	$7	$1	11%	—	$6 – $11
4	WellCare fee schedule · outpatient · +2 other terms	131	$7	$7	$0	4%	—	$6 – $8
5	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	126	$7	$6	$0	5%	—	$6 – $10
6	Devoted fee schedule · outpatient · +2 other terms	122	$6	$6	$0	1%	—	$6 – $7
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$7	$7	$0	4%	—	$6 – $7
8	Molina fee schedule · outpatient · +3 other terms	69	$9	$9	$4	39%	—	$6 – $17
9	Superior Healthplan fee schedule · outpatient	40	$7	$7	$0	1%	—	$6 – $7
10	Anthem fee schedule · outpatient · +2 other terms	31	$6	$6	$0	2%	—	$6 – $7
11	Oscar fee schedule · outpatient · +2 other terms	27	$6	$7	$1	20%	—	$6 – $11
12	Medicare facility · fee schedule · outpatient · +2 other terms	19	$6	$6	$0	2%	—	$6 – $7
13	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$8	$8	$0	3%	—	$7 – $8
14	Cigna fee schedule · outpatient · +2 other terms	17	$7	$7	$2	31%	—	$6 – $16
15	Ambetter facility · fee schedule · outpatient · +3 other terms	16	$12	$11	$4	36%	—	$6 – $16
16	Clover fee schedule · outpatient · +3 other terms	15	$7	$7	$0	1%	—	$6 – $7
17	Kaiser fee schedule · outpatient · +2 other terms	15	$7	$7	$0	2%	—	$6 – $7
18	Optum facility · per diem · outpatient · +3 other terms	10	$6	$6	—	—	—	$6 – $6
19	Highmark case rate · outpatient · +2 other terms	5	$6	$8	$3	35%	—	$6 – $14
20	Medica facility · fee schedule · outpatient	5	$7	$7	$0	0%	—	$7 – $7
21	Tricare facility · fee schedule · outpatient	5	$6	$6	—	—	—	$6 – $6
22	Excellus case rate · outpatient	4	$9	$9	$3	37%	—	$6 – $14
23	Bcbs Nj facility · other · outpatient	3	$6	$6	—	—	—	$6 – $6
24	Magellan facility · fee schedule · outpatient · +1 other terms	3	$7	$7	—	—	—	$7 – $7
25	Sanford Health Plan case rate · outpatient	3	$9	$9	$1	10%	—	$7 – $10

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