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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

Facilitymedian $0 · 10th–90th $0–$60%20%10th90th$0Professionalmedian $0 · 10th–90th $0–$00%50%90th$0$0.1$1.0$20.0$500.0$10.0K$200.0K

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
$0.31 / $1.41 / $5.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.11 / $0.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.36 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.14 / $0.14 / $0.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.17 / $0.27 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.08 / $83.18 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.05 / $0.10 / $3.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.36 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $61.66
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $3.24 / $4.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.17