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New York 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
$0.10 / $0.13 / $1.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.13 / $0.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.13 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.53
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.25
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.25 / $0.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.41
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $85.00 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.18
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.25 / $0.25
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.25 / $0.25