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NDC 00904-5853-61

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

Reported by 14 hospitals in the network under the fee schedule methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

$0

Average

$23

Median

$5

High

$277

Hospitals reporting this code

#HospitalLocation
1Portland Adventist Medical CenterPortland, OR$0$241$277$526$136
2Mark Twain Medical CenterSan Andreas, CA$1$3$3$4$1
3Franciscan Health SystemTacoma, WA$2$5$5$7$2
4Harrison Medical CenterSilverdale, WA$2$5$5$9$3
5Enumclaw Regional Hospital AssociationEnumclaw, WA$1$2$2$9$2
6Highline Medical CenterBurien, WA$1$4$4$9$2
7Franciscan Health SystemGig Harbor, WA$2$5$5$7$2
8Saint Clare HospitalLakewood, WA$2$5$5$7$2
9St Francis Community HospitalFederal Way, WA$2$5$5$7$2
10Vanderbilt Wilson County HospitalLebanon, TN$0$0$0$1—
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