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Fomepizole Injection

Missouri rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $7$280%20%10th90th$12Professionalmedian $12 · 10th–90th $11$150%50%10th90th$12$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
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$15.14
Typical High
$20.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$20.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$11.48
Typical High
$32.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$21.38
Typical High
$23.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$18.20
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.30
Typical High
$14.45
United
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$20.89
United
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.30
Typical High
$15.14