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Arizona rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.34 / $120.87 / $8,825.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $44.32 / $6,732.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $53.51 / $53.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.67 / $143.75 / $261.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.55 / $49.77 / $55.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $40.29 / $51.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $52.97 / $99.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $44.59 / $95.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $44.59