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Idaho rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $4,036.74 / $10,025.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $55.33 / $6,732.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $34.63 / $40.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.32 / $50.37 / $70.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.71 / $50.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.99 / $46.66 / $91.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.52 / $75.30 / $125.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.52 / $48.35 / $48.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $42.71