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Pennsylvania 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
$0.15 / $0.49 / $8.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.43 / $0.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $17.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.12 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.34
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.43 / $23.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.49 / $6.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.45 / $1.86
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03