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Hydroxyzine Pamoate, Oral

Tennessee 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 October 2026.

How much does Hydroxyzine Pamoate, Oral cost?

$0.13

Typical physician fee. In Tennessee, October 2026.

Insurers have agreed to pay about $0.13 for this service. Most negotiated rates run $0.12 to $0.14.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $0Professionalmedian $0 · 10th to 90th $0 to $62
$0.1$0.5$2$10$50facility $0professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.12
Median
$0.12
Typical High
$0.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.12
Median
$0.12
Typical High
$0.12
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$0.06
Median
$0.06
Typical High
$0.06
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.02
Median
$0.02
Typical High
$0.02
Cigna
Setting
Facility
Modifier
None
Typical Low
$0.14
Median
$0.16
Typical High
$0.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.13
Median
$0.13
Typical High
$0.13
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
United
Setting
Professional
Modifier
None
Typical Low
$0.12
Median
$0.13
Typical High
$0.13

Where Tennessee sits

The same service costs 32.4 times more in Montana than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Tennessee· 47th of 51

$0.13

MT $2.88HI $0.09

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.