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South 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
$0.08 / $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