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Ohio 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
$0.47 / $1.21 / $5.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $0.76 / $2.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.45 / $0.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.33
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.98 / $85.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.42