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South Dakota 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
$0.56 / $0.56 / $0.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.76 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.76 / $1.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.12 / $1.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.10 / $1.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.52
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47