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South Carolina 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–$30%10%20%10th90th$0Professionalmedian $0 · 10th–90th $0–$00%50%10th$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $8.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.88 / $4.37 / $8.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.27 / $0.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.15 / $0.23 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.43 / $0.56 / $6.46
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.11 / $0.15 / $0.56
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.24 / $3.24 / $3.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.13