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New York 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 / $130.68 / $4,133.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $100.12 / $1,693.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.30 / $79.30 / $99.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $354.04
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.14 / $204.14 / $214.35
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.14 / $204.14 / $204.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $93.52 / $250.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.55 / $154.31 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.95 / $108.18 / $124.41
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.72
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.72
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.98 / $187.98 / $187.98
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $93.52 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $177.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $155.31
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.72 / $99.72 / $99.72
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.72