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Louisiana rates for HCPCS Q5111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.40 / $190.46 / $9,801.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $107.40 / $473.01
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.04 / $209.41 / $252.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.19 / $316.42 / $369.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.19 / $124.19 / $126.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,126.16 / $2,126.16 / $2,126.16
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.70 / $106.33 / $132.69