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Iowa rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.34 / $364.88 / $12,335.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $110.13 / $13,488.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.99 / $100.99 / $100.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.01 / $135.47 / $143.77
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $127.34 / $606.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $135.47 / $234.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $115.45 / $187.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.45 / $201.73 / $301.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.45 / $163.98 / $647.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $117.96
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $103.71 / $103.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $103.71 / $103.71