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Kentucky 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.15 / $0.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.87 / $2.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.79 / $2.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.13 / $0.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.14