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Idaho rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,265.80 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $107.15 / $3,388.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $112.20 / $186.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $112.20 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $123.03 / $4,365.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $109.65 / $123.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $186.21 / $416.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $117.49 / $117.49
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $109.65