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North Dakota rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $186.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $100.12 / $125.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.54 / $108.08 / $109.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.41 / $107.92 / $108.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.99 / $100.99 / $116.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.01 / $115.01 / $143.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $148.69 / $311.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $117.19 / $129.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $110.35 / $119.85