go back

Virginia 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 / $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