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Oregon 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
$0.34 / $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