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Idaho 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
$0.35 / $0.88 / $11.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.37 / $0.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $1,500.00 / $3,900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34