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South Dakota 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–$70%20%40%10th90th$0Professionalmedian $0 · 10th–90th $0–$30%10%20%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
$1.86 / $2.04 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.38 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.11 / $0.14 / $0.36
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $61.66
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.88 / $3.24 / $4.57
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $2.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.15
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13