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Michigan rates for HCPCS Q0161

Chlorpromazine Hydrochloride 5 Mg Oral Fda Approved Prescription Anti-Emetic For Use As A Complete Therapeutic Substitute For An Iv Anti- Emetic At The Time Of Chemotherapy Treatment Not To Exceed A 48 Hour Dosage Regimen (Code Deleted 01/01/02 Reinstated 01/01/14) Factor Ix (Antihemophilic Factor Recombinant) Peri.U.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.21 / $0.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $0.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.60 / $2.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.37 / $0.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.35