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Michigan 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 $2 · 10th–90th $0–$30%20%10th90th$2Professionalmedian $0 · 10th–90th $0–$00%20%10th90th$0$0.0$0.1$0.5$2.0$10.0$50.0

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.74 / $2.40 / $4.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $3.02 / $4.79
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.17 / $0.36 / $0.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.21 / $2.04 / $2.57
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.70 / $1.86 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.22
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.27 / $0.85 / $2.69
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.30 / $0.35 / $0.44
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $0.13 / $0.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.12 / $3.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.14