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Alaska rates for HCPCS Q5120

Injection, pegfilgrastim-bmez (ZIEXTENZO), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $7,585.78 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $316.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $380.19
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $549.54 / $870.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $316.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $120.23 / $128.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $177.83 / $354.81