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Louisiana 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
$0.56 / $0.56 / $0.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.56 / $0.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $3.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.27 / $2.31
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.47 / $0.51