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Wisconsin rates for HCPCS Q0177

Hydroxyzine Pamoate 25mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.22 / $0.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $6.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.15 / $2.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.88 / $3.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $1.05 / $1.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.40 / $3.79
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $1.99
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.12 / $2.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $61.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $2.23
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $4.53 / $6.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $61.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $3.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.16