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Oregon 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
$0.48 / $0.48 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.49 / $1.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.56 / $1.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.25 / $0.28
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.59 / $1.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.59 / $0.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.54