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West Virginia rates for HCPCS Q5112

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.19 / $21.99 / $24.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $21.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.00 / $19.00 / $28.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $44.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.34 / $90.07 / $90.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $20.90 / $105.98