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Massachusetts rates for HCPCS Q5108

Injection Pegfilgrastim-Jmdb (Fulphila) Biosimilar 0.5 Mg (Desc Revised 04/01/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $4,434.99 / $6,527.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $103.09 / $124.45
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.11 / $265.67 / $818.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $266.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.37 / $126.49 / $269.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $125.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $163.86 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.90 / $162.90 / $191.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $433.15
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,865.94 / $2,154.13 / $4,429.77
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.50 / $417.50 / $1,345.20
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $266.16
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.61 / $164.11 / $346.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $110.35 / $266.16