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Washington rates for HCPCS Q0161

Chlorpromazine HCl, 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
$0.33 / $0.33 / $0.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.33 / $0.34
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $85.00 / $85.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $2.23 / $850.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $7.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
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
$0.35 / $0.35 / $0.36
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.38 / $0.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35