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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

Current code20 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
Cascade Valley HospitalArlington$3.59 – $5.541 plan$2.87 – $4.43$3.59 – $5.54
Highline Medical CenterBurienFile dated 2026-02-28—$1.90 – $3.79$6.20 – $12.40
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01———
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01———
PeaceHealth Peace Island Medical CenterFriday Harbor—$1.92 – $35.96$2.96 – $55.32
PeaceHealth Southwest Medical CenteVancouver—$1.92 – $35.96$2.96 – $55.32
PeaceHealth St John Medical CenterLongview—$1.92 – $35.96$2.96 – $55.32
PeaceHealth St Joseph Medical CenterBellingham—$1.92 – $35.96$2.96 – $55.32
PeaceHealth United General Medical CenterSedro Woolley—$1.92 – $35.96$2.96 – $55.32
Providence Centralia HospitalCentraliaFile dated 2026-04-01———
Seattle Children's HospitalSeattle$1.29 – $1.6312 plans$5.00$5.00
Skagit Valley HospitalMount Vernon—$2.87 – $4.43$3.59 – $5.54
St Anthony HospitalGig HarborFile dated 2026-02-28—$1.89 – $3.78$6.20 – $12.40
St Clare HospitalLakewoodFile dated 2026-02-28—$1.79 – $3.58$6.20 – $12.40
St Elizabeth HospitalEnumclawFile dated 2026-02-28$1.06 – $2.575 plans$2.20 – $4.39$6.20 – $12.40
St Francis Community HospitalFederal WayFile dated 2026-02-28—$1.95 – $3.90$6.20 – $12.40
St Joseph Medical CenterTacomaFile dated 2026-02-28—$2.06 – $4.11$6.20 – $12.40
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$2.74 – $5.48$6.20 – $12.40
Three Rivers HospitalBrewster$4.391 plan$6.27$6.27
Virginia Mason Medical CenterSeattle——$1.60

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.