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Phenothiazine Level Test

South Dakota rates for HCPCS 84022

Measures how much phenothiazine medicine is present in a sample. Phenothiazines are an older family of drugs used for psychosis, severe nausea and agitation, and the result helps a prescriber judge whether the amount in the body is about right or too high.

Rates data updated October 2026.

How much rates vary

Facilitymedian $41 · 10th to 90th $24 to $60Professionalmedian $41 · 10th to 90th $25 to $51
$50$100facility $41professional $41

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
None
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$40.74
Typical High
$51.29
Medica
Setting
Facility
Modifier
None
Typical Low
$23.99
Median
$23.99
Typical High
$100.00