go back

South Dakota rates for HCPCS Q0167

Dronabinol, 2.5 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
$1.35 / $1.35 / $1.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $2.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.50 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $2.84 / $5.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.68 / $610.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $2.27 / $4.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $2.00 / $6.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.48 / $1.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.49
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68