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Georgia 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
$0.08 / $0.78 / $5.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.10 / $0.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.11 / $9.59
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $4.94 / $6.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.12