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South Carolina 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
$1.24 / $16.00 / $44.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.52 / $0.67
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.42 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.34 / $0.34