| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $354.81 | $870.96 | $1,047.13 | |
Health Alliance Plan
| Professional | $354.81 | $389.05 | $501.19 | |
United
| Professional | $575.44 | $575.44 | $575.44 |
Unspecified oral dosage form, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $354.81 | $870.96 | $1,047.13 | |
Health Alliance Plan
| Professional | $354.81 | $389.05 | $501.19 | |
United
| Professional | $575.44 | $575.44 | $575.44 |