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South Dakota rates for HCPCS Q0169

Promethazine HCl, 12.5 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
$0.10 / $0.10 / $0.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.15 / $0.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $64.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $1.00 / $1.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $1.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06