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Montana rates for HCPCS Q5112

Injection Trastuzumab-Dttb Biosimilar (Ontruzant) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.19 / $320.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.79 / $32.79 / $32.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $32.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $22.99 / $42.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.01 / $32.96 / $52.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00