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Montana rates for HCPCS Q5113

Injection Trastuzumab-Pkrb Biosimilar (Herzuma) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $86.71 / $317.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.36 / $84.36 / $84.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $84.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.37 / $75.55 / $84.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.23 / $75.26 / $89.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37