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Wyoming rates for HCPCS Q5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $44.59 / $7,404.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.70 / $46.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $75.00 / $75.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.63 / $34.63 / $34.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $45.02 / $51.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29