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South Carolina 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 / $8.00 / $17.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.43 / $0.55
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.42 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $55.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $0.08