go back

Maine 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
$1.70 / $1.70 / $9.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $9.12 / $58.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.34 / $0.43