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Louisiana rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.19 / $32.99 / $63.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.19 / $110.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.28 / $27.28 / $40.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.28 / $27.28 / $27.83
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $19.00 / $23.75