go back

Kentucky 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
$0.28 / $0.28 / $0.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.99 / $0.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.80 / $0.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.66 / $0.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.84 / $1.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.87