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Fomepizole Injection

Montana rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $8$190%50%10th90th$12Professionalmedian $12 · 10th–90th $10$130%20%40%10th90th$12$10.0$20.0$50.0

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
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$23.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$12.88
Typical High
$12.88
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$12.02
Typical High
$12.30
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$12.02
Typical High
$12.30
Providence
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$10.96
Typical High
$23.99
Providence
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$13.49
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$12.30