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Hydroxyzine Pamoate, Oral

Massachusetts 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 October 2026.

How much does Hydroxyzine Pamoate, Oral cost?

$0.13

Typical negotiated rate. In Massachusetts, October 2026.

Insurers have agreed to pay about $0.13 for this service. The price depends on where it is billed: about $0.13 from a physician practice, and about $0.25 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.13$0.13 to $0.16
FacilityA hospital or hospital-owned outpatient department$0.25$0.14 to $0.43

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $3Professionalmedian $0 · 10th to 90th $0 to $62
$0.1$1$10$100$1K$10Kfacility $0professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.10
Median
$0.13
Typical High
$0.13
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.12
Median
$0.13
Typical High
$0.13
AllWays Health Partners
Setting
Facility
Modifier
None
Typical Low
$0.10
Median
$0.33
Typical High
$0.40
AllWays Health Partners
Setting
Professional
Modifier
None
Typical Low
$0.10
Median
$0.13
Typical High
$61.66
BCBS Massachusetts
Setting
Facility
Modifier
None
Typical Low
$0.14
Median
$0.16
Typical High
$0.31
Cigna
Setting
Facility
Modifier
None
Typical Low
$0.17
Median
$0.27
Typical High
$0.56
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Fallon Health
Setting
Facility
Modifier
None
Typical Low
$2.88
Median
$3.39
Typical High
$5,888.44
Fallon Health
Setting
Professional
Modifier
None
Typical Low
$2.88
Median
$2.88
Typical High
$3.39
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Mass General Brigham
Setting
Facility
Modifier
None
Typical Low
$0.10
Median
$0.33
Typical High
$0.40
Mass General Brigham
Setting
Professional
Modifier
None
Typical Low
$0.10
Median
$0.13
Typical High
$61.66
United
Setting
Professional
Modifier
None
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Well Sense
Setting
Facility
Modifier
None
Typical Low
$0.12
Median
$0.13
Typical High
$0.26
Well Sense
Setting
Professional
Modifier
None
Typical Low
$0.13
Median
$0.13
Typical High
$0.18
3 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$0.06
Median
$0.07
Typical High
$0.07
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.02
Median
$0.03
Typical High
$0.03
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.02
Median
$0.02
Typical High
$0.02

Where Massachusetts sits

The same service costs 32.4 times more in Montana than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Massachusetts· 12th of 51

$0.13

MT $2.88HI $0.09

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.