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North Carolina 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
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $60.26
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
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.36 / $0.91
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $5.62