go back

South Dakota 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 / $0.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.84 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.54 / $1.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $4.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.12 / $1.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.10 / $1.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.92