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North Dakota 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
$0.12 / $0.12 / $0.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.38 / $0.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.17 / $3.49
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 / $0.14