go back

Texas 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 / $1.46 / $18.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $1.24
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.10 / $42.10 / $42.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.42 / $0.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.31 / $0.59
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.69 / $0.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.41 / $0.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.49