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Oregon 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
$0.35 / $0.35 / $0.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.49 / $1.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.56 / $1.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.37 / $0.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.60 / $1.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $2,250,000.00 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $2.63 / $2.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.97