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Washington 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
$0.30 / $0.30 / $0.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.34 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $4.33 / $5.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.84 / $3.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $1.03
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $1.04 / $1.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.01 / $1.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.01 / $1.91
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 / $0.84