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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
$56.23 / $4,786.30 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $38.90 / $6,309.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $40.74 / $97.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $114.82 / $181.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $46.77 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $38.02 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $40.74
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $44.67 / $83.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $91.20 / $97.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $46.77 / $81.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $39.81 / $50.12