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Washington rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $38.00 / $45.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.57 / $35.34
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.45 / $58.66 / $461.50
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $21.95 / $145.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.34 / $19.00 / $57.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $20.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.19 / $175.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $163.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.64 / $23.75 / $65.97
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.04 / $64.63 / $109.02
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.61 / $33.09 / $51.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $46.93 / $100.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $20.90 / $22.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $22.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.37 / $26.37 / $26.37