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Pennsylvania 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 / $0.21 / $0.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $0.21 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.21 / $0.21
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $1.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.15 / $0.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $5.23
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.14