go back

Utah 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
$1.48 / $1.91 / $1.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.15 / $30.20
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $0.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.32 / $0.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83