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Georgia 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
$0.34 / $3.60 / $104.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.37 / $0.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.39 / $0.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.36 / $0.50
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.35 / $2.13
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.92 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.51