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Tennessee rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.12 / $169.05 / $1,742.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $125.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.75 / $208.75 / $208.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $125.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.50 / $1,345.20 / $1,345.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $202.23