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Hydroxyzine Pamoate, Oral

Nebraska 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

Rates data updated July 2026.

Facilitymedian $0 · 10th–90th $0$00%10%20%10th90th$0Professionalmedian $0 · 10th–90th $0$00%50%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
Setting
Facility
Modifier
Global
Typical Low
$0.12
Median
$0.24
Typical High
$0.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.12
Typical High
$0.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.03
Median
$0.04
Typical High
$0.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.04
Median
$0.04
Typical High
$0.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.47
Typical High
$4.79
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.08
Median
$0.16
Typical High
$1.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$61.66
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$3.24
Typical High
$4.79
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$3.55
Typical High
$4.79
United
Setting
Facility
Modifier
Global
Typical Low
$0.05
Median
$2.45
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.15