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Wisconsin rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.57 / $50.49 / $50.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.57 / $26.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.15 / $40.85 / $42.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $28.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.01 / $28.12 / $30.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $45.71 / $95.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $36.61 / $69.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.76 / $39.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.99 / $22.20 / $33.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.99 / $24.48 / $126.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $50.30 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.76 / $28.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $32.15 / $91.98
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $90.07 / $461.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $92.30 / $126.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.68 / $26.68 / $26.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.95 / $23.94