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Ohio rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $69.13 / $2,320.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $31.23 / $1,667.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.75 / $52.95 / $87.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $57.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $30.32 / $51.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $40.93
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 / $524.99
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.71 / $24.71 / $28.30
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $524.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.78 / $34.98 / $42.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.75 / $37.58