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
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $0.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.50 / $0.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $4.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.10 / $1.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.98