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Montana 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

Facilitymedian $1 · 10th–90th $0–$10%20%40%10th90th$1Professionalmedian $1 · 10th–90th $0–$10%50%10th90th$1$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.26 / $1.26 / $1.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.05 / $1.23 / $4.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.48 / $0.48 / $1.05
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.15
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.15
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.45 / $0.56 / $1.35
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.48 / $0.59 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $0.47 / $0.62