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Vermont rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $37.15 / $42.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $41.69 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $47.86
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $47.86 / $47.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $39.81 / $77.62