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Wisconsin rates for HCPCS Q5110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.44 / $0.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.31 / $153.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.65 / $0.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.63 / $0.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.45 / $0.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.32 / $0.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.38 / $1.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.33 / $0.44