Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HYDROXYZINE PAMOATE 25 MG ORAL CAP [3777]
Low
$0
Average
$3.1k
Median
$1
High
$14.9k
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
31 hospitals; the 90th percentile is 78577.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
32 hospital rates
iThe hospitals that file a Ambetter rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Hospital Authority of Miller County Colquitt, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3 | $3 | — | — | 2–20 | $3 – $3 |
| 2 | Indiana University Health Jay Inc. Portland, IN percent of total billed charges · outpatientfrom % of charges | 1 | $7.8k | $7.8k | — | — | 1–10 | $7.8k – $7.8k |
| 3 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 4 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 5 | CentraState Medical Center Freehold Township, NJ other · outpatient | 1 | $14.9k | $14.9k | — | — | — | $14.9k – $14.9k |
| 6 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 8 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 9 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 10 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 1 | $14.9k | $14.9k | — | — | — | $14.9k – $14.9k |
| 11 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · inpatient | 2 | $7 | $7 | $0 | 3% | — | $7 – $8 |
| 12 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 2 | $7 | $7 | $0 | 3% | — | $7 – $8 |
| 13 | Eisenhower Medical Center Rancho Mirage, CA percent of total billed charges · bothfrom % of charges | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 14 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 15 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 1 | $14.9k | $14.9k | — | — | — | $14.9k – $14.9k |
| 17 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $3 | $6 | $4 | 60% | — | $3 – $11 |
| 18 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 19 | MADISON ST JOSEPH HEALTH CENTER Madisonville, TX fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 20 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 21 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 22 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 24 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 25 | Morristown Medical Center Morristown, NJ other · outpatient | 1 | $14.9k | $14.9k | — | — | — | $14.9k – $14.9k |
← Payers reporting HCPCS Q0177 · Snapshot 20261111T120946Z-9134e7f7