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South Carolina 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
$0.32 / $0.32 / $1.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.32 / $0.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.50 / $0.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $1.76 / $2.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.33 / $0.33