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Texas 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
$0.52 / $0.74 / $4.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.71 / $1.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.35 / $218.35 / $218.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.56 / $0.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.61 / $1.17
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.56 / $1.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.66