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Arizona rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $380.19 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $125.89 / $7,943.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $75.86 / $114.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $229.09 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $33.88 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $30.20 / $40.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $120.23 / $120.23