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Washington 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
$82.53 / $150.06 / $8,253.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $78.78 / $137.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.47 / $117.12 / $498.40
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $82.53 / $3,766.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.78 / $75.02 / $186.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.02 / $75.02 / $92.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.03 / $101.29 / $233.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $108.32 / $224.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $83.25 / $101.29
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.03 / $86.24 / $225.09
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.42 / $128.74 / $225.30
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.77 / $98.13 / $177.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.08 / $93.70 / $176.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $82.53 / $90.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $75.03 / $90.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $75.03 / $77.05