go back

Illinois 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 / $3.27 / $7.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $2.70 / $8.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
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 / $0.41
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.08 / $1.43
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.37