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Hydroxyzine Pamoate, Oral

Louisiana 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$20%20%40%10th90th$0Professionalmedian $0 · 10th–90th $0$00%20%10th90th$0$0.1$0.1$0.2$0.5$1.0$2.0

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
$0.15
Median
$0.15
Typical High
$3.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.12
Typical High
$0.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.28
Median
$0.28
Typical High
$0.28
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.28
Median
$0.28
Typical High
$0.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.15
Typical High
$0.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
United
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.00
Typical High
$2.45
United
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.14