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Fomepizole Injection

South Dakota rates for HCPCS J1451

Injection, fomepizole, 15 mg

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $12$170%50%90th$12Professionalmedian $12 · 10th–90th $7$150%20%10th90th$12$10.0$20.0

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
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$6.76
Typical High
$8.51
Medica
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$17.78
Typical High
$37.15
Medica
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$12.30
Typical High
$13.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.30
Typical High
$14.45
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$12.30
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$12.30