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Idaho rates for HCPCS Q0177

Hydroxyzine Pamoate 25mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.10 / $29.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.13
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13