go back

Michigan 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 / $0.45 / $1.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $1.55 / $2.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.85
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.88 / $2.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.50 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $75.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.51