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Wisconsin rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.50 / $5,503.79 / $7,264.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $41.50 / $5,814.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.54 / $86.62 / $89.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $60.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.17 / $59.63 / $64.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $72.45 / $150.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $52.65 / $78.73
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $41.91 / $58.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $45.04 / $64.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.59 / $49.64 / $233.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $41.91 / $58.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.71 / $62.75 / $176.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.29 / $63.75 / $382.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $95.37 / $233.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.57 / $56.57 / $56.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $41.10 / $50.97