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California rates for HCPCS Q0163

Diphenhydramine HCl, 50 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.56 / $9.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $70.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.28
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.42 / $1.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $638.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.13 / $34.13 / $34.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.59 / $60.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.28 / $0.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04