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Minnesota 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
$0.15 / $0.15 / $0.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.62 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.31 / $0.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $1.19 / $1.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.41 / $0.48
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $1.09 / $1.75
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $3.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $61.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.24