go back

Arizona 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
$0.60 / $1.12 / $1.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $1.48 / $2.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.45 / $0.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.55 / $1.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47