go back

Utah 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
$0.46 / $0.46 / $0.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.24 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.87 / $1.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47