go back

New Jersey 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 / $1.00 / $1.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.34 / $0.35
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.40 / $3.40 / $3.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.36 / $0.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.50 / $0.59
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.39