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Alaska rates for HCPCS Q5112

Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.47 / $143.12 / $143.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $21.10 / $49.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.14 / $35.34 / $116.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $50.62
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $148.36 / $233.13
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.97 / $127.16 / $127.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $35.34 / $211.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $41.00 / $105.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $28.50 / $57.00