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Virginia 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 / $0.52 / $1.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.62
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.27 / $1.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $85.00
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
$0.64 / $0.80 / $1.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.56 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.00 / $1.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.96 / $1.96 / $1.96
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.96 / $1.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.49