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Minnesota 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 / $0.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $1.00 / $2.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.43 / $1.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $2.39 / $2.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.83 / $0.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.18 / $2.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $0.56 / $1.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.85