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Washington 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
$0.09 / $0.09 / $0.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $85.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.42 / $64.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.65 / $1.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.65 / $1.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.42 / $0.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08