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New Jersey rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.12 / $204.31 / $3,170.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $100.12
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.46 / $614.46 / $614.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $156.90 / $203.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.60 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.25 / $125.12 / $125.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $104.58 / $121.48