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Fomepizole Injection

Wisconsin rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $7$270%20%10th90th$12Professionalmedian $12 · 10th–90th $9$210%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
$12.02
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$15.14
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$14.13
Typical High
$14.45
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$12.30
Typical High
$22.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$16.98
Typical High
$33.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$12.02
Typical High
$13.49
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$12.02
Typical High
$15.14
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$9.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$7.76
Typical High
$15.14
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.22
Molina
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$12.88
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$12.02
Typical High
$15.14
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$9.55
Quartz
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$16.60
Typical High
$22.91
Quartz
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$38.90
Typical High
$100.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$12.88
Typical High
$12.88
Security Health
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$23.44
United
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$15.14
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.98