go back

Virginia 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
$0.35 / $0.76 / $14.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $85.00
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
$0.31 / $0.41 / $0.80
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.35 / $0.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.54 / $1.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.36