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Montana 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–$60%20%10th90th$1Professionalmedian $0 · 10th–90th $0–$30%50%90th$0$0.1$1.0$20.0$500.0$10.0K$200.0K

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
$5.75 / $5.75 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $3.98 / $3.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.51 / $69,183.10 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $3.63 / $13.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $3.16
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.39 / $3.39 / $3.47
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.39 / $3.39 / $3.47
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.12 / $0.19 / $2.40
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13