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Wisconsin 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 / $0.18 / $0.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $2.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $1.05 / $1.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.40 / $1.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.33
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $64.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.33
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $1.51 / $2.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $64.58
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.06 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10