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Vermont rates for HCPCS Q5108

Injection Pegfilgrastim-Jmdb (Fulphila) Biosimilar 0.5 Mg (Desc Revised 04/01/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $110.13 / $178.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $127.81 / $213.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $127.81 / $213.01
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $99.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.17 / $105.08 / $152.49