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Massachusetts rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $62.83 / $3,943.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.70 / $4,650.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.32 / $111.24 / $382.05
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.30 / $228.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.19 / $49.48 / $96.13
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.48 / $83.43 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $67.67 / $79.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,966.70 / $3,352.26 / $5,088.32
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.64 / $382.05 / $382.05
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.71 / $228.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.30 / $76.90