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Maine rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.08 / $44.08 / $47.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.76 / $26.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.89 / $21.12 / $60.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $20.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.00 / $90.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.08 / $44.08 / $47.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $20.78 / $29.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $27.55