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Indiana rates for HCPCS Q0175

Perphenazine 4 Mg Oral Fda Approved Prescription Anti-Emetic For Use As A Complete Therapeutic Substitute For An Iv Anti- Emetic At The Time Of Chemotherapy Treatment Not To Exceed A 48 Hour Dosage Regimen (Special Coverage Instructions Apply)

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