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Alaska rates for HCPCS Q0175

Perphenazine, 4 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
$0.75 / $2.66 / $2.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.76 / $1.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.95 / $0.95
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $0.78 / $1.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.67 / $0.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.76 / $1.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.59 / $0.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.71 / $1.19