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Hydroxyzine Pamoate, Oral

Washington, DC 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

Rates data updated July 2026.

Facilitymedian $0 · 10th–90th $0$00%50%90th$0Professionalmedian $0 · 10th–90th $0$00%50%10th$0$0.1$0.5$2.0$10.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.13
Typical High
$0.13
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.20
Median
$0.20
Typical High
$0.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.34
Typical High
$4.57
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
United
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.14