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Maine rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.98 / $4,137.16 / $11,089.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $103.09 / $125.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.93 / $120.41 / $314.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $120.05
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.98 / $2,604.42 / $11,455.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.12 / $103.13 / $136.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $148.69