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Hydroxyzine Pamoate, Oral

Maine 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 $1 · 10th–90th $0$10%50%10th$1Professionalmedian $0 · 10th–90th $0$00%50%10th$0$0.1$0.2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.02
Typical High
$1.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.13
Typical High
$0.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.12
Typical High
$0.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.15
Typical High
$0.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.02
Typical High
$1.02
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.13
United
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.23