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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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.26 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.14 / $2.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.45 / $1.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.51 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.79 / $0.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $2.40 / $2.82
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.56 / $1.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.72