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Nebraska rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $213.99 / $3,849.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $2,523.34 / $3,254.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.16 / $106.61 / $112.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.48 / $120.81 / $127.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $115.01 / $143.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.71 / $122.54 / $1,345.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.71 / $112.90 / $134.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.47 / $214.50 / $353.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.45 / $163.98 / $647.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.17 / $99.13 / $117.96