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West 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 / $0.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $0.57 / $0.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.56 / $0.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.56