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North Carolina 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
$0.08 / $0.10 / $4.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.13 / $1.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $3.00 / $3.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.16
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $61.16 / $61.16