| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.98 | $3.98 | $3.98 | |
BCBS
| Professional | $0.04 | $0.04 | $0.04 | |
Cigna
| Professional | $0.13 | $0.13 | $0.40 | |
United
| Professional | $0.13 | $0.13 | $0.26 |
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 | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.98 | $3.98 | $3.98 | |
BCBS
| Professional | $0.04 | $0.04 | $0.04 | |
Cigna
| Professional | $0.13 | $0.13 | $0.40 | |
United
| Professional | $0.13 | $0.13 | $0.26 |