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New Hampshire 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 / $11,462.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.14 / $54.58 / $137.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.99 / $30.32 / $30.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $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
$31.81 / $49.24 / $93.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $32.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.04 / $459.13 / $3,000.00