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Missouri 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 / $0.59 / $0.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $0.80 / $1.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.45 / $0.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.56 / $1.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.47 / $0.54