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Connecticut rates for HCPCS Q5111

Injection Pegfilgrastim-Cbqv (Udenyca) Biosimilar 0.5 Mg (Desc Revised 4/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.59 / $216.93 / $318.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $107.40 / $164.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $160.29 / $318.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.36 / $116.47 / $183.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.70 / $106.33 / $118.37