Oral dolasetron mesylate 50 mg tablet

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)

Payers reporting HCPCS S0174

Payer pricing summary

Low

Average

$56

Median

$52

High

$182

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +6 other terms	182	$56	$92	$66	71%	—	$27 – $258
2	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	166	$117	$128	$81	64%	—	$1 – $409
3	Aetna fee schedule · outpatient · +7 other terms	100	$60	$66	$49	74%	—	$24 – $346
4	Humana fee schedule · outpatient · +5 other terms	71	$130	$209	$134	64%	—	$28 – $382
5	Kaiser fee schedule · both · +1 other terms	43	$60	$57	$15	27%	—	$41 – $82
6	Anthem fee schedule · outpatient · +6 other terms	35	$34	$54	$41	75%	—	$30 – $423
7	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$207	$188	$63	33%	—	$77 – $325
8	UnitedHealthcare fee schedule · both · +7 other terms	26	$30	$34	$6	18%	—	$30 – $54
9	Caresource facility · case rate · outpatient · +1 other terms	15	$9	$10	$2	23%	—	$6 – $15
10	Molina facility · case rate · outpatient · +2 other terms	15	$9	$10	$2	23%	—	$6 – $15
11	Wellmark fee schedule · both · +2 other terms	13	$30	$30	—	—	—	$30 – $30
12	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$86	$66	$36	54%	—	$30 – $108
13	Bcbs Nj fee schedule · outpatient	12	$29	$29	—	—	—	$29 – $29
14	Highmark fee schedule · outpatient · +3 other terms	11	$33	$33	$0	1%	—	$30 – $34
15	Optum facility · case rate · outpatient	11	$8	$9	$2	22%	—	$7 – $13
16	Medica fee schedule · outpatient · +4 other terms	10	$60	$60	$15	25%	—	$36 – $77
17	Aetna Better Health fee schedule · inpatient · +1 other terms	7	$29	$29	—	—	—	$29 – $29
18	Bcbs La fee schedule · outpatient · +1 other terms	6	$78	$73	$14	19%	—	$32 – $78
19	Excellus facility · fee schedule · outpatient	5	$48	$54	$34	63%	—	$30 – $141
20	First Health facility · fee schedule · outpatient · +1 other terms	4	$89	$89	—	—	—	$89 – $89
21	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$34	$34	—	—	—	$34 – $34
22	Sanford Health Plan fee schedule · outpatient · +1 other terms	3	$30	$30	—	—	—	$30 – $30
23	Amerihealth Caritas professional · fee schedule · outpatient	2	$64	$64	$1	1%	—	$64 – $66
24	Bcbs Ca fee schedule · outpatient · +1 other terms	1	$30	$30	—	—	—	$30 – $30
25	Bcbs Id professional · fee schedule · outpatient	1	$30	$30	—	—	—	$30 – $30

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