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Illinois 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
$0.45 / $0.90 / $1.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $4.48 / $23.59
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 / $0.56
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.90 / $200.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.50