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Louisiana rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.70 / $66.89 / $6,677.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.70 / $53.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $44.59 / $86.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.24 / $51.24 / $76.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.24 / $51.24 / $52.26
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,507.42 / $2,507.42 / $2,507.42
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.07 / $40.29 / $50.28