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Rhode Island rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.27 / $49.27 / $49.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $13.18 / $13.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $13.64 / $13.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43