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Arizona rates for HCPCS Q5108

Injection, pegfilgrastim-jmdb (Fulphila), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.49 / $201.23 / $5,142.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.12 / $124.90 / $5,010.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.17 / $376.79 / $629.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.88 / $117.64 / $779.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $163.13 / $417.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $103.71 / $114.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $110.35