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Missouri rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.10 / $3,578.34 / $8,163.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $48.35 / $7,182.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $44.59 / $53.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $54.39 / $144.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.65 / $51.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $48.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $46.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $55.62 / $114.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $47.27 / $233.37
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.28 / $51.28 / $51.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.08 / $40.29 / $49.36