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New Mexico 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
$0.62 / $0.62 / $0.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.64 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.48 / $0.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47