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Idaho rates for HCPCS Q5113

Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $91.20 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $56.23 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $61.66 / $87.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $61.66 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $54.95 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $54.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $61.66 / $77.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $58.88 / $72.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $52.48 / $61.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $77.62 / $154.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $61.66 / $69.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $58.88