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Ohio 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 / $1.22 / $1.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $1.04 / $3.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.60 / $0.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.56