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South Carolina rates for HCPCS Q5113

Injection Trastuzumab-Pkrb Biosimilar (Herzuma) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.84 / $3,718.79 / $20,259.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.53 / $70.06 / $93.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.97 / $120.79 / $183.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $82.90 / $99.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.71 / $69.37 / $95.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $70.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.40 / $69.37 / $123.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $36.40 / $84.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $71.34 / $169.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.96 / $73.53 / $87.26