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Pennsylvania rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.73 / $3,160.35 / $13,848.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $41.50 / $5,814.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $46.82 / $49.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.63 / $42.91 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.04 / $41.04 / $41.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $40.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.83 / $39.83 / $59.77
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.11 / $28.47 / $33.89
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.48 / $56.54 / $61.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.04 / $135.55 / $14,143.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $46.33 / $5,814.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.40 / $75.42 / $125.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $40.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $41.56
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.60 / $42.60 / $49.43
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.60 / $42.60 / $49.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $42.71 / $76.90