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Missouri rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.10 / $219.19 / $2,799.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $101.11 / $125.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $168.52 / $356.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $123.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $99.13 / $99.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $208.75 / $1,345.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.97 / $109.68 / $129.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $104.83 / $183.39