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Utah rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.04 / $22.04 / $22.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.57 / $320.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.48 / $33.09 / $50.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $27.48 / $38.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.84 / $76.91 / $131.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.90 / $25.75 / $27.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00