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Virginia 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
$0.13 / $1.78 / $7.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $2.39 / $3.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.13 / $1.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.77 / $3.52 / $4.73
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.14