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South Carolina 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
$111.65 / $9,272.70 / $11,016.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $107.40 / $146.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.65 / $429.80 / $535.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $321.39 / $471.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.32 / $106.33 / $189.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $115.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $396.63 / $496.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.09 / $353.68 / $396.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.64 / $171.78 / $340.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.51 / $112.71 / $123.34