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Montana rates for HCPCS J1451

Injection, fomepizole, 15 mg

Facilitymedian $12 · 10th–90th $8–$190%50%10th90th$12Professionalmedian $12 · 10th–90th $12–$130%50%90th$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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $23.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $12.88 / $12.88
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.59 / $12.02 / $12.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.59 / $12.02 / $12.30
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $23.99
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.41 / $13.49 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $12.30