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Texas 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 / $4.28 / $9.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.67 / $1.29
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.58 / $64.58 / $64.58
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.61 / $1.17
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.55 / $4.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.11