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Nebraska rates for HCPCS Q0175

Perphenazine 4 Mg Oral Fda Approved Prescription Anti-Emetic For Use As A Complete Therapeutic Substitute For An Iv Anti- Emetic At The Time Of Chemotherapy Treatment Not To Exceed A 48 Hour Dosage Regimen (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.98 / $1.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.62 / $0.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.62 / $0.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.98 / $1.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.68 / $0.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.98 / $1.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.10 / $1.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.56