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Virginia rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.08 / $235.20 / $6,723.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $104.08 / $113.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $209.16 / $337.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.12 / $229.99 / $347.08
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 / $99.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.26 / $118.96 / $313.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $99.13 / $588.36
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.17 / $119.95 / $198.31
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.17 / $119.95 / $198.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $105.08 / $128.87