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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
Professional
Modifier
Low / Median / High Price
$1.26 / $1.51 / $1.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.98 / $1.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.54
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 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $1.32
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.75