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Washington rates for HCPCS Q5108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.04 / $215.72 / $7,187.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $109.04 / $2,757.20
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.54 / $221.64 / $431.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.04 / $135.94 / $208.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.52 / $99.13 / $225.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $121.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $103.71 / $112.90
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.13 / $123.91 / $311.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.29 / $202.19 / $343.11
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.94 / $135.94 / $208.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.14 / $177.31 / $441.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.04 / $109.04 / $109.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.13 / $99.13 / $118.96