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Illinois rates for HCPCS Q0180

Dolasetron Mesylate 100 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 24 Hour Dosage Regimen (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.90 / $115.80 / $133.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.90 / $57.90 / $61.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.40 / $180.57 / $940.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.52 / $61.52 / $61.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.52 / $61.52 / $72.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.40 / $112.60 / $143.19
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.99 / $67.82 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $60.32 / $65.14