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Utah 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
$60.08 / $60.08 / $60.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.90 / $60.08 / $62.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.52 / $61.52 / $61.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $119.38 / $131.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.31 / $74.31 / $78.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $60.32 / $60.32