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New Mexico 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
$99.13 / $161.68 / $161.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $100.12 / $740.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.06 / $1,222.09 / $2,638.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.29 / $132.52 / $178.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $135.53
Providence
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 / $99.13 / $99.13