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Fomepizole Injection

Pennsylvania rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $19 · 10th–90th $13$380%20%10th90th$19Professionalmedian $13 · 10th–90th $13$160%50%90th$13$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$12.88
Median
$19.95
Typical High
$36.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$16.22
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$12.59
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$44.67
Typical High
$47.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$19.50
Typical High
$33.11
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.98