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

Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.

Prices for HCPCS Q0177 by hospital
Hospital	Medicare Advantage rates (lowest – highest)	Cash price	List price (before discounts)
Cascade Valley HospitalArlington	$1.33 – $10.931 plan	$1.07 – $1.75	$1.33 – $2.18
Olympic Medical CenterPort AngelesFile dated 2026-06-24	—	$6.37	$7.96
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01	—	$7.20 – $10.83	$10.29 – $15.47
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	—	$1.07 – $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 during a hospital stay, 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.