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South 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
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $1.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.52 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.84 / $0.84