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Michigan 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
$0.33 / $1.29 / $1.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.12 / $2.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.52
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.92 / $1.99
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.37 / $0.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $75.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.37