go back

Pennsylvania 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
$0.35 / $0.98 / $7.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.41
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.49 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $1.24 / $2.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $1.40 / $7.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.60 / $0.85
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.51