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Texas 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 / $0.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $5.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.46 / $0.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.61 / $1.17
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.47 / $0.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $1.18