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Idaho rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.99 / $27.99 / $6,840.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.04 / $37.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $23.58 / $30.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.36 / $40.17 / $502.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $37.90 / $37.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.71 / $24.71 / $24.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.41 / $381.44 / $780.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.59 / $36.39 / $36.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $33.75