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Nationwide rates for HCPCS Q0177

Hydroxyzine pamoate, 25 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
$0.45 / $2.14 / $11.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.16 / $0.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $3.24 / $7.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.13 / $0.13