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Utah rates for HCPCS Q5111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.35 / $2,220.04 / $4,950.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $109.52 / $2,012.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.57 / $190.61 / $233.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $136.10 / $204.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.39 / $351.65 / $481.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.96 / $144.12 / $151.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33