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Fomepizole Injection

Texas rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $21 · 10th–90th $9$450%10%10th90th$21Professionalmedian $15 · 10th–90th $13$170%50%10th90th$15$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$13.18
Median
$21.38
Typical High
$34.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$14.79
Typical High
$17.38
BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$24.55
Typical High
$46.77
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$30.20
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$15.14
Typical High
$20.89
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$12.59
Molina
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$10.47
Providence
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$15.14
Typical High
$40.74
Providence
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$6.61
Typical High
$10.72
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$12.30
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.60