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Louisiana rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.27 / $30.63 / $97.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.27 / $30.32 / $33.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.97 / $272.23 / $317.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.98 / $21.98 / $22.42
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $51.70