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Maryland 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
$0.48 / $3.10 / $3.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $1.27 / $1.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
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
$0.65 / $0.84 / $1.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51