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Washington rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.32 / $6,076.28 / $10,467.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $44.07 / $5,550.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.43 / $83.67 / $382.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $46.09 / $236.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $40.29 / $93.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $45.02
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $44.11 / $154.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $117.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.31 / $49.04 / $63.20
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $49.05 / $95.54
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.99 / $68.16 / $124.40
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.25 / $61.13 / $100.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.32 / $55.78 / $139.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $44.32 / $48.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $48.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $51.84