go back

Virginia 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 / $2.29 / $21.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $85.00
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
$0.26 / $0.73 / $1.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.10 / $0.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $1.00 / $1.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09