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Wisconsin 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
$0.45 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.55 / $2.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $2.11 / $3.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.80 / $1.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.74
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $218.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.74
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.51 / $2.27
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.27 / $218.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.59