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Oregon rates for HCPCS Q0169

Promethazine Hydrochloride 12.5 Mg Oral Fda Approved Prescription Anti-Emetic For Use As A Complete Therapeutic Substitute For An Iv Anti-Emetic At The Time Of Chemotherapy Treatment Not To Exceed A 48 Hour Dosage Regimen (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $0.18 / $0.18
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
$1.29 / $1.49 / $1.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.11 / $0.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $0.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09