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South Dakota rates for HCPCS Q0164

Prochlorperazine maleate, 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
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.42 / $0.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.53 / $0.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $42.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.48 / $0.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.48 / $0.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.37
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