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Mississippi 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
$99.12 / $1,742.86 / $3,127.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $104.08 / $2,452.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.16 / $127.16 / $127.16
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $103.10 / $143.74