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Massachusetts 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
$0.35 / $2.78 / $6.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.35
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 / $0.35 / $42.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.48 / $0.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.54 / $0.74
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
$83.43 / $4,618.00 / $9,239.00
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
$3.45 / $4.12 / $47.43
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $42.10
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.64