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Wisconsin 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 $0 · 10th–90th $0–$40%20%10th90th$0Professionalmedian $0 · 10th–90th $0–$60%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
$4.47 / $4.47 / $4.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.11 / $0.11 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $5.62
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $1.78 / $2.40
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.70 / $1.86 / $3.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.17 / $1.05 / $1.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.44 / $3.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.12 / $0.13 / $2.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $0.12 / $3.98
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.10 / $61.66
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $50.12 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.09 / $2.09 / $2.09
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $2.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.40 / $4.27 / $6.92
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.13 / $0.14 / $61.66
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $5.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.95 / $1.95 / $4.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.10 / $0.13 / $0.15