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Maine rates for HCPCS Q5113

Injection Trastuzumab-Pkrb Biosimilar (Herzuma) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.94 / $160.94 / $173.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $72.17 / $95.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $77.12 / $219.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $76.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.37 / $69.37 / $95.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.94 / $160.94 / $173.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.14 / $78.27 / $104.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $121.40