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Utah rates for HCPCS Q5113

Injection Trastuzumab-Pkrb Biosimilar (Herzuma) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.47 / $80.47 / $11,434.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $71.45 / $89.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.04 / $92.62 / $106.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $77.48 / $96.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.86 / $126.51 / $181.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.31 / $94.03 / $98.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37