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Texas 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $1.06 / $10.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $2.00 / $3.34
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $61.16 / $61.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $1.83 / $3.51
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.14