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Nebraska 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 / $0.67 / $0.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.95 / $0.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.95 / $0.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.98 / $1.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.48 / $0.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.84 / $4.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.98 / $1.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.10 / $1.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.84 / $0.84