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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

Facilitymedian $1 · 10th–90th $0–$20%20%10th90th$1Professionalmedian $0 · 10th–90th $0–$00%50%10th90th$0$0.1$0.2$1.0$5.0$20.0

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
$1.86 / $2.04 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $3.98 / $3.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.31 / $0.62 / $0.62
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.25 / $0.31 / $0.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $1.26 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.40 / $0.48
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.98 / $1.20 / $1.41
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.38 / $0.38 / $0.51
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.12 / $3.72
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $61.66
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.18