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Colorado 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
$0.33 / $2.27 / $12.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.61 / $1.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.42 / $0.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.00 / $155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34