go back

Pennsylvania rates for HCPCS Q0161

Chlorpromazine Hydrochloride 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 (Code Deleted 01/01/02 Reinstated 01/01/14) Factor Ix (Antihemophilic Factor Recombinant) Peri.U.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.77 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.33 / $0.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.51 / $6.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.56 / $0.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.33 / $0.56
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.43