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Oregon 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 / $0.82 / $2.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.64 / $0.75 / $0.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.44 / $0.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.44
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.44 / $0.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.44 / $0.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.39