go back

Montana rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $64,565.42 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $371.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $371.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $120.23 / $169.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23