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Missouri 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 $0 · 10th–90th $0–$60%10%20%10th90th$0Professionalmedian $0 · 10th–90th $0–$00%20%40%10th90th$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.51 / $2.82 / $5.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.11 / $1.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.14 / $0.22 / $0.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.11 / $0.15
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.27 / $0.34 / $0.37
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.15 / $0.21 / $0.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.12 / $0.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $61.66
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.13 / $3.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.13