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New Jersey 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
$0.04 / $0.13 / $5.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.11 / $0.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $5.62 / $7.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.34
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $9,332.54 / $23,988.33
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $1.78 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02