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New Mexico 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.83 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.98 / $1.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.45 / $1.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83