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New Hampshire 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 / $26.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $26.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.40 / $29.64 / $78.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.34 / $19.00 / $19.00
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 / $31.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $20.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.07 / $99.08 / $126.10