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Idaho rates for HCPCS Q5111

Injection, pegfilgrastim-cbqv (Udenyca), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.04 / $136.04 / $7,189.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $136.04 / $3,078.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.32 / $100.32 / $106.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.97 / $136.04 / $190.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $112.71 / $132.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.41 / $122.00 / $319.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.50 / $224.17 / $423.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.96 / $127.60 / $127.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $112.71