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New York 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
$1.02 / $1.02 / $1.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.76 / $0.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.05 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.95
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $0.87 / $1.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $4.27 / $4.37
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.78 / $0.87
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $0.93
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.87 / $0.87
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.78 / $0.87