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California 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
$0.12 / $0.32 / $22.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.14 / $0.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.11 / $0.20
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.13 / $0.15
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.27
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.26 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $61.16 / $61.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.08 / $60.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.17 / $3.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.13 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.23