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South Carolina rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,069.98 / $5,189.29 / $7,163.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.28 / $41.91 / $3,642.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $49.05 / $51.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.41 / $115.21 / $174.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $71.25 / $85.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $63.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $84.02 / $100.36
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.78 / $97.51 / $100.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.82 / $47.65 / $107.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.25 / $42.71 / $47.95