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 [20700]
Arlington, TX
See all hospitals reporting HCPCS Q0177 →Price type
AMH Cath Labs LLC’s median price of $1 is 15% below the median hospital's median price ($1), higher than 47% of the 1,165 hospitals reporting HCPCS Q0177. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield exchange fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Blue Cross Blue Shield hmo fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 3 | Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 4 | Blue Cross Blue Shield ppo fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 5 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 6 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Aetna whole health percent of total billed charges · inpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 10 | Blue Cross Blue Shield traditional fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 11 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 12 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $0 | $0 | — | — | — | $0 – $0 |
| 13 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 15 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 16 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 17 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 18 | Aetna coventry percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 20 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 21 | Phcs ppo percent of total billed charges · inpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 22 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 23 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 24 | Cigna indemnity percent of total billed charges · inpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
| 25 | Cigna indemnity percent of total billed charges · outpatientfrom % of charges | $1 | $1 | — | — | — | $1 – $1 |
Last updated: Apr 21, 2026
See Hydroxyzine pamoate 25 mg oral capsule pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.