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Utah rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.99 / $3,032.67 / $6,159.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.99 / $114.99 / $114.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.58 / $165.49 / $190.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.71 / $317.68 / $428.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.17 / $99.13 / $110.35