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Wisconsin 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 / $0.62 / $0.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.94 / $2.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $2.11 / $3.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.94 / $1.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.79
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $4.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.79
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.08 / $1.58 / $2.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $90.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $3.40 / $4.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $1.06