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California 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
$0.46 / $1.05 / $1.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.53 / $0.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.53 / $0.99
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.49 / $0.81
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.47 / $1.22
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.26 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.35 / $218.35 / $218.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $1.20 / $60.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.56 / $1.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.85