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Illinois 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
$1.91 / $1.95 / $1.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $2.82 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $5.62 / $7.08
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.07 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83