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Alaska rates for HCPCS Q0169

Promethazine HCl, 12.5 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $4.66 / $9.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.14 / $0.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.48 / $0.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.22
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.14 / $0.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.09 / $0.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.20