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
$14
Median
$1
High
$985
Each hospital's average Molina rate, under the methodology and billing class chosen below.
108 hospitals; the 90th percentile is 69.2× 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.
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141 hospital rates
iThe hospitals that file a Molina 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 | Wheeling Hospital, Inc. Wheeling, WV facility · other · outpatient | 1 | $0 | $0 | — | — | 14 | $0 – $0 |
| 2 | Public Hospital Dis No 1 Skagit dba Skagit Valley Hospital Vernon, WA fee schedule · both | 1 | $985 | $985 | — | — | 6–60 | $985 – $985 |
| 3 | North Canyon Medical Center Inc. Gooding, ID facility · percent of total billed charges · outpatientfrom % of charges | 1 | $8 | $8 | — | — | 1–10 | $8 – $8 |
| 4 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 5 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | BRONXCARE HEALTH SYSTEM Bronx, NY other · both | 2 | $0 | $0 | $0 | 20% | — | $0 – $0 |
| 7 | BRONXCARE HEALTH SYSTEM Bronx, NY other · inpatient | 2 | $0 | $0 | $0 | 100% | — | $0 – $0 |
| 8 | BRONXCARE HEALTH SYSTEM Bronx, NY other · outpatient | 2 | $0 | $0 | $0 | 17% | — | $0 – $0 |
| 9 | BRONXCARE HEALTH SYSTEM Bronx, NY other · both | 2 | $0 | $0 | $0 | 20% | — | $0 – $0 |
| 10 | BRONXCARE HEALTH SYSTEM Bronx, NY other · inpatient | 2 | $0 | $0 | $0 | 100% | — | $0 – $0 |
| 11 | BRONXCARE HEALTH SYSTEM Bronx, NY other · outpatient | 2 | $0 | $0 | $0 | 17% | — | $0 – $0 |
| 12 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 13 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 14 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 15 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 16 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 17 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · inpatientfrom % of charges | 2 | $1 | $1 | $0 | 9% | — | $1 – $1 |
| 18 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · outpatientfrom % of charges | 2 | $1 | $1 | $0 | 9% | — | $1 – $1 |
| 19 | Carle Eureka Hospital Eureka, IL percent of total billed charges · inpatientfrom % of charges | 2 | $1 | $1 | $0 | 9% | — | $1 – $1 |
| 20 | Carle Eureka Hospital Eureka, IL percent of total billed charges · outpatientfrom % of charges | 2 | $1 | $1 | $0 | 43% | — | $1 – $2 |
| 21 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 22 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · inpatientfrom % of charges | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 23 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 24 | Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 25 | Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
← Payers reporting HCPCS Q0177 · Snapshot 20261111T120946Z-9134e7f7