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Hydroxyzine Pamoate, Oral

Iowa 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$10%50%10th90th$0Professionalmedian $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
$0.13
Typical High
$1.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.38
Typical High
$2.51
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$2.19
Typical High
$3.47
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.10
Median
$0.13
Typical High
$3.24
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$61.66
Midlands
Setting
Professional
Modifier
Global
Typical Low
$0.09
Median
$2.88
Typical High
$4.57
Midlands
Setting
Professional
Modifier
Global
Typical Low
$0.09
Median
$4.07
Typical High
$5.50
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.15
Typical High
$3.31
United
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.14
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.13
Typical High
$0.13