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Pennsylvania 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 $0 · 10th–90th $0–$90%20%10th90th$0Professionalmedian $0 · 10th–90th $0–$00%50%10th90th$0$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$0.51 / $0.60 / $9.33
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.04 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.46 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.26
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.05 / $0.05 / $0.11
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.11 / $0.11 / $0.11
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.31
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.13 / $0.15