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Utah rates for HCPCS Q5114

Injection Trastuzumab-Dkst Biosimilar (Ogivri) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.74 / $8,031.15 / $12,413.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.70 / $265.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.08 / $64.44 / $74.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $50.36 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.36 / $112.68 / $161.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.32 / $54.62 / $57.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29