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Indiana 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 / $1.12 / $2.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.94 / $1.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.55 / $0.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.60 / $0.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.75
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.50