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North Carolina 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
$0.48 / $0.48 / $0.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.54 / $1.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.63 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.00 / $1.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.56
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.35 / $218.35 / $218.35