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South Dakota rates for HCPCS Q0180

Dolasetron mesylate, 100 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 24-hour dosage regimen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.38 / $72.38 / $72.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.90 / $61.52 / $72.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.97 / $104.25 / $130.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.75 / $101.24 / $178.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $60.32 / $477.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.19 / $97.28 / $141.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.25 / $93.08 / $141.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.31 / $60.31 / $60.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.32 / $60.32 / $69.37
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.12 / $59.12 / $59.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.12 / $59.12 / $59.12