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Virginia rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $57.54 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $54.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $52.48 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $45.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $27.54 / $27.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $27.54 / $95.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $30.20 / $107.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $100.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $35.48 / $100.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $35.48 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $27.54 / $47.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $28.84 / $32.36