Fomepizole injection, per 15 mg

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-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

FOMEPIZOLE 1 GRAM/ML IV SOLN [22185]

Payers reporting HCPCS J1451

Payer pricing summary

Low

Average

$1.2k

Median

$924

High

$4.8k

Payer rate distribution

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Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	420	$15	$200	$819	410%	1–10	$0 – $9.4k
2	UnitedHealthcare fee schedule · outpatient · +29 other terms	693	$11	$234	$1.2k	524%	—	$0 – $34.2k
3	Aetna fee schedule · outpatient · +25 other terms	461	$9	$638	$2.7k	419%	—	$1 – $59.9k
4	Cigna fee schedule · outpatient · +24 other terms	359	$19	$492	$1.3k	272%	—	$1 – $12.6k
5	Humana fee schedule · outpatient · +22 other terms	331	$7	$823	$3.7k	451%	—	$0 – $66.6k
6	Anthem fee schedule · outpatient · +24 other terms	146	$13	$98	$584	593%	—	$1 – $7.6k
7	WellCare fee schedule · outpatient · +17 other terms	135	$6	$123	$444	362%	—	$6 – $3.0k
8	Molina fee schedule · outpatient · +25 other terms	132	$10	$144	$453	314%	—	$1 – $3.3k
9	MultiPlan fee schedule · outpatient · +14 other terms	100	$3.9k	$5.1k	$7.1k	140%	—	$6 – $66.6k
10	Kaiser fee schedule · outpatient · +18 other terms	96	$13	$980	$1.7k	178%	—	$1 – $9.6k
11	Ambetter facility · fee schedule · outpatient · +15 other terms	87	$12	$29	$139	473%	—	$6 – $1.1k
12	Devoted fee schedule · outpatient · +12 other terms	63	$6	$12	$59	489%	—	$6 – $628
13	Optum facility · fee schedule · outpatient · +19 other terms	56	$6	$148	$529	357%	—	$5 – $2.5k
14	Highmark facility · fee schedule · outpatient · +16 other terms	51	$14	$40	$43	108%	—	$5 – $199
15	Caresource fee schedule · outpatient · +15 other terms	46	$10	$81	$479	589%	—	$1 – $5.9k
16	Medica fee schedule · outpatient · +18 other terms	46	$607	$830	$1.7k	203%	—	$7 – $6.6k
17	Oscar facility · fee schedule · outpatient · +13 other terms	43	$10	$10	$1	13%	—	$6 – $12
18	Regence facility · fee schedule · both · +17 other terms	37	$1.2k	$1.5k	$759	51%	—	$16 – $4.5k
19	Excellus facility · fee schedule · both · +9 other terms	36	$1.3k	$1.5k	$703	47%	—	$736 – $4.5k
20	Carefirst facility · fee schedule · both · +7 other terms	35	$1.3k	$1.5k	$732	48%	—	$736 – $4.5k
21	Medicare fee schedule · outpatient · +13 other terms	35	$6	$6	$0	7%	—	$6 – $10
22	Premera facility · fee schedule · both · +10 other terms	35	$1.3k	$1.5k	$739	48%	—	$736 – $4.5k
23	Wellmark facility · fee schedule · both · +14 other terms	35	$1.2k	$1.5k	$704	48%	—	$707 – $4.5k
24	First Health fee schedule · outpatient · +16 other terms	33	$3.4k	$4.0k	$2.2k	54%	—	$6 – $12.7k
25	Clover facility · fee schedule · outpatient · +7 other terms	30	$7	$7	$0	3%	—	$6 – $7

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