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Pennsylvania 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 / $73.89 / $9,185.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.86 / $7,920.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.45 / $32.29 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.88 / $30.88 / $30.88
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.32 / $909.32 / $1,231.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.83 / $85.09 / $9,185.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.27 / $41.63 / $4,270.47
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $30.32 / $30.32
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.94 / $89.94 / $104.37
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.94 / $89.94 / $104.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $32.14 / $55.49