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Arkansas rates for HCPCS Q5114

Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.35 / $53.51 / $812.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $43.92 / $5,814.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $46.82 / $55.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $45.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $51.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.28 / $51.28 / $64.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.08 / $41.50 / $51.57