go back

Alaska rates for HCPCS Q0173

Trimethobenzamide HCl, 250 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
$1.66 / $1.66 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.47 / $1.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.47 / $1.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.26 / $2.09