go back

New Hampshire 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 / $0.48 / $0.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.48 / $0.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.71 / $0.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.48
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.98 / $3.03