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South Carolina 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
$104.08 / $396.14 / $4,812.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $104.08 / $168.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.02 / $425.22 / $553.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.09 / $198.31 / $292.47
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.08 / $124.90 / $344.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.25 / $357.25 / $357.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $118.96