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Pennsylvania 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 / $1.12 / $1.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.52
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.56 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.72 / $1.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.61