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Texas 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 / $44.23 / $3,285.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.63 / $33.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.20 / $893.95 / $1,783.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.97 / $27.97 / $27.97
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.55 / $1,527.75 / $1,527.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.99 / $43.36 / $692.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $28.73 / $44.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $30.32 / $44.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.73 / $30.32 / $32.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.75 / $33.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.71 / $24.71 / $40.93