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HCPCS Q0177

Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Current code19 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Cascade Valley HospitalArlington$1.00 – $10.767 plans$1.07 – $1.75$1.33 – $2.18
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$5.82 – $7.372 plans——
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01$4.371 plan——
Olympic Medical CenterPort AngelesFile dated 2026-06-24$4.44 – $7.966 plans$6.37$7.96
PeaceHealth Peace Island Medical CenterFriday Harbor—$1.48 – $20.16$2.27 – $31.01
PeaceHealth Southwest Medical CenteVancouver—$1.48 – $20.16$2.27 – $31.01
PeaceHealth St John Medical CenterLongview—$1.48 – $20.16$2.27 – $31.01
PeaceHealth St Joseph Medical CenterBellingham—$1.48 – $20.16$2.27 – $31.01
PeaceHealth United General Medical CenterSedro Woolley—$1.48 – $20.16$2.27 – $31.01
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$7.20 – $10.83$10.29 – $15.47
Providence Centralia HospitalCentraliaFile dated 2026-04-01$5.82 – $7.372 plans——
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$7.20 – $10.83$10.29 – $15.47
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$7.56$10.80
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$10.53 – $11.24$15.04 – $16.06
Skagit Valley HospitalMount Vernon$1.06 – $2.076 plans$1.07 – $1.75$1.33 – $2.18
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$4.06$8.45
Swedish IssaquahIssaquahFile dated 2026-04-01—$4.06$8.45
Swedish Medical CenterSeattleFile dated 2026-04-01—$4.06$8.45
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$4.06$8.45

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.