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New Hampshire 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
$61.52 / $61.52 / $73.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.94 / $61.52 / $61.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.11 / $90.48 / $120.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $61.52 / $61.52
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 / $61.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.24 / $101.24 / $177.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $60.32 / $100.61
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.79 / $104.27 / $132.71