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Idaho rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.99 / $21.99 / $25.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $21.10 / $26.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.34 / $13.34 / $19.00
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
$20.90 / $23.75 / $33.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $20.14 / $23.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.17 / $35.04 / $56.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $48.68 / $98.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.68 / $22.80 / $22.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $20.14