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Michigan 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 / $0.27 / $6.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.18 / $0.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.33 / $0.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.31 / $0.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.06 / $2.92
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02