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Iowa 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
$1.05 / $1.05 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $1.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.79 / $8.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.50 / $1.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $4.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.10 / $1.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.35 / $1.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.87