go back

Idaho 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

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

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $22.91 / $29.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.06 / $0.39
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.14 / $0.15 / $0.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.12 / $0.15 / $0.66
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.05 / $0.06 / $2.14
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.49
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.20 / $0.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.13