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North Carolina 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 / $0.43 / $4.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $0.21 / $0.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.08 / $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 / $0.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.41 / $0.55
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.00 / $1.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $5.48 / $5.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.58 / $64.58 / $64.58