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Louisiana rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.12 / $108.90 / $4,233.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $100.12 / $125.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.29 / $316.42 / $369.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.19 / $124.19 / $126.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,370.71 / $2,370.71 / $2,370.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $93.52 / $99.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $139.47