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New Hampshire 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–$40%10%10th90th$1Professionalmedian $0 · 10th–90th $0–$00%50%10th90th$0$0.1$0.2$1.0$5.0$20.0

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
$1.07 / $2.14 / $5.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $3.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.18 / $0.27 / $0.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $0.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.15 / $0.26 / $0.36
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.23
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.08 / $0.13 / $0.16