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North Carolina 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
$0.15 / $0.36 / $0.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.54 / $0.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.36 / $0.50
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 / $0.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.37 / $0.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $1.09 / $1.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.41
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $42.10