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South Carolina rates for HCPCS Q0177

Hydroxyzine Pamoate 25mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $8.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $4.32 / $8.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.22 / $2.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.13 / $0.14