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Georgia 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
$0.10 / $0.12 / $17.34
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
$0.13 / $0.14 / $0.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.13 / $0.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $2.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.79 / $2.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $85.00
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
$0.10 / $0.13 / $3.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.15