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South Dakota rates for HCPCS Q0161

Chlorpromazine Hydrochloride 5 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 48 Hour Dosage Regimen (Code Deleted 01/01/02 Reinstated 01/01/14) Factor Ix (Antihemophilic Factor Recombinant) Peri.U.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.33 / $0.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.54 / $0.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $850.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.36
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35