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Montana rates for HCPCS Q5110

Injection, filgrastim-aafi, biosimilar, (Nivestym), 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $108.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.33 / $0.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30