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  4. /NDC 00904-5853-61

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 at Portland Adventist Medical Center

Portland, OR

Pricing by billing methodology

Price type

All methodologies

$175

Aggregated across all available billing methodologies for this code.

Case rate

Not reported

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

Fee schedule

$241

Reflects negotiated fee schedule rates with commercial payers.

Per diem

Not reported

Reflects a negotiated per diem rate paid per day of care.

Percent of billed charges

$144

Reflects a negotiated percentage of total billed charges.

Other

Not reported

Reflects a payer-specific billing methodology not covered by the standard categories.

Last updated: May 26, 2026

Compare to other hospitals

See 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 pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.

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