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Montana rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,709.22 / $6,709.22 / $6,709.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.62 / $33.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.29 / $34.29 / $34.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.29 / $34.29 / $34.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $32.90 / $392.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32