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New Mexico rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.52 / $69.52 / $25,372.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.70 / $55.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.13 / $47.13 / $57.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $40.29 / $64.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $67.39 / $90.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $40.29 / $74.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $67.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $42.71