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Massachusetts 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
$0.30 / $0.30 / $0.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.30
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $1.29 / $90.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.84 / $4.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.03 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.83 / $1.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $90.00 / $90.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.84 / $4.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.84 / $1.12