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Maryland 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
$0.09 / $0.72 / $2.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $5.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $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
$0.26 / $0.77 / $1.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08