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Vermont 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
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $1.09