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Montana 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
$0.46 / $0.95 / $6.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.22 / $4.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.09 / $1.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.40 / $1.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $1.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08