go back

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $1.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.13
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.40 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.13 / $61.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.17 / $0.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.10 / $3.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $61.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.17