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Massachusetts 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
$1.91 / $4.90 / $7.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.31 / $1.12
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.35 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $41.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.52 / $0.63
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $4.07 / $47.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.35 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $41.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $1.29 / $1.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.41