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Vermont rates for HCPCS Q5111

Injection Pegfilgrastim-Cbqv (Udenyca) Biosimilar 0.5 Mg (Desc Revised 4/1/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $106.33 / $994.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.66 / $140.66 / $140.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.32 / $185.21 / $308.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $308.69
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.32 / $185.21 / $308.69
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $106.33 / $308.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.33 / $112.71 / $318.99