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Alaska 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
$0.68 / $3.79 / $7.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.55 / $0.77
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.48 / $0.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.49 / $0.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.55 / $0.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.42 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.51 / $0.95