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Washington 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 $3 · 10th–90th $0–$50%10%10th90th$3Professionalmedian $0 · 10th–90th $0–$40%10%20%10th90th$0$0.1$0.2$1.0$5.0$20.0$100.0

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
$1.10 / $2.63 / $7.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.49
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.24 / $0.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.13
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $2.88 / $5.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $2.88 / $5.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $75.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $0.10
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $0.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.49 / $0.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.07 / $0.10 / $4.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.13