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Maine rates for HCPCS Q5111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.59 / $246.69 / $265.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $110.59 / $164.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.57 / $118.21 / $336.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $116.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $106.33 / $354.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.69 / $246.69 / $265.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $111.65 / $164.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $167.65