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Hydroxyzine Pamoate, Oral

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

Rates data updated July 2026.

Facilitymedian $1 · 10th–90th $0$40%20%10th90th$1Professionalmedian $0 · 10th–90th $0$00%20%40%10th90th$0$0.1$0.2$1.0$5.0$20.0$100.0

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
$0.12
Median
$0.32
Typical High
$12.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.12
Typical High
$0.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.65
Typical High
$0.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.04
Median
$0.04
Typical High
$0.14
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.34
Typical High
$2.45
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1.70
Median
$1.86
Typical High
$2.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.15
Typical High
$0.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$2.69
United
Setting
Facility
Modifier
Global
Typical Low
$2.00
Median
$3.89
Typical High
$5.50
United
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.15