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Wisconsin 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
$0.33 / $1.52 / $7.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $1.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $1.15 / $1.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.39 / $0.52
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.44
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $42.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.44
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.75 / $1.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.43 / $42.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.62 / $0.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.44