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Maine rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.47 / $93.47 / $100.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.28 / $41.91 / $53.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.83 / $44.79 / $127.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $44.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $40.29 / $63.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.47 / $93.47 / $100.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.31 / $55.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $73.06