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Washington 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 / $2.79 / $39.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.50 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.50 / $42.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.35 / $0.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.56 / $0.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.56 / $0.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.35
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.37 / $0.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.50 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35