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Hydroxyzine Pamoate, Oral

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

Rates data updated July 2026.

How much does Hydroxyzine Pamoate, Oral cost?

$0.15

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $0.15 for this service. The price depends on where it is billed: about $0.15 from a physician practice, and about $0.13 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.15$0.13 to $0.38
FacilityA hospital or hospital-owned outpatient department$0.13$0.12 to $0.14

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $0Professionalmedian $0 · 10th to 90th $0 to $0
$0.1$1.0$10.0facility $0professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.12
Median
$0.13
Typical High
$0.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.38
Median
$0.38
Typical High
$0.47
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.11
Median
$0.14
Typical High
$0.36
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$61.66
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$3.24
Typical High
$4.57
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$0.26
Median
$0.26
Typical High
$0.26
United
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.14
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$0.13
Median
$0.13
Typical High
$0.13

Where South Dakota sits

The same service costs 4.4 times more in West Virginia than in Texas. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

South Dakota $0.15 · 3rd of 51
WV $0.52TX $0.12

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.