go back

South Dakota rates for HCPCS Q0161

Chlorpromazine HCl, 5 mg, oral, 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
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