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Idaho rates for HCPCS J9355

Injection Trastuzumab Excludes Biosimilar 10 Mg (Desc Revised 7/1/2019)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.18 / $76.18 / $87.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $82.53 / $103.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.78 / $70.78 / $75.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.02 / $75.02 / $75.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.61 / $85.51 / $123.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $79.53 / $93.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.95 / $72.97 / $147.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.27 / $105.41 / $199.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.53 / $90.03 / $90.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $75.03 / $83.31