go back

Arizona 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
$0.13 / $0.30 / $9.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.38 / $0.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.11 / $0.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.12 / $3.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $61.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13