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Illinois 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 $1 · 10th–90th $0–$70%10%10th90th$1Professionalmedian $0 · 10th–90th $0–$30%20%40%10th90th$0$0.1$0.5$5.0$50.0$500.0

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
$0.21 / $4.07 / $7.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $1.82 / $1.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $1.41 / $6.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.18 / $0.24 / $0.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.15
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.62 / $2.57 / $3.31
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.07 / $2,511.89 / $2,511.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.34 / $3.24 / $3.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.13