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Ohio rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.23 / $288.31 / $6,142.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $100.12 / $550.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.06 / $173.13 / $284.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $103.70 / $197.81
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.83 / $132.83 / $132.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $168.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $133.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $93.52 / $99.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $279.18
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.87 / $279.08 / $603.03
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $279.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.08 / $138.78 / $158.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $106.17 / $122.85