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Utah 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 $13 · 10th–90th $1–$370%20%10th90th$13Professionalmedian $0 · 10th–90th $0–$10%20%40%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
$0.98 / $13.49 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.65
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.12 / $0.27
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $1.02 / $1.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13