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Maine rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.34 / $70.34 / $75.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $31.54 / $33.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.34 / $36.83 / $96.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.71 / $30.32 / $30.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $36.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.34 / $70.34 / $75.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.62 / $33.17 / $41.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $53.06