go back

New Hampshire 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 / $103.71 / $4,280.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $99.13 / $103.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.15 / $178.43 / $449.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $103.71
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.01 / $160.99 / $305.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $105.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.88 / $440.05 / $672.14