go back

Connecticut rates for HCPCS Q0164

Prochlorperazine Maleate 5 Mg Oral Fda Approved Prescription Anti-Emetic For Use As A Complete Therapeutic Substitute For An Iv Anti-Emetic At The Time Of Chemotherapy Treatment Not To Exceed A 48 Hour Dosage Regimen (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $1.14 / $5.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.49 / $1.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.48 / $0.56
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.34 / $0.36