go back

Missouri 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
$0.63 / $5.50 / $24.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.43 / $1.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.31
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $33.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02