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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
$0.34 / $1.71 / $58.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.35 / $0.41
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 / $0.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $85.00
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
$1.71 / $9.18 / $58.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.35 / $0.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.49