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Pennsylvania 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 / $287.27 / $8,938.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $103.13 / $3,684.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.41 / $107.54 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.87 / $102.87 / $102.87
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.06 / $311.42 / $390.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.74 / $315.27 / $9,919.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $110.13 / $2,757.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $99.13 / $99.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.54 / $136.54 / $158.44
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.54 / $136.54 / $158.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $170.85