go back

Utah rates for HCPCS Q5120

Injection Pegfilgrastim-Bmez (Ziextenzo) Biosimilar 0.5 Mg (Desc Revised 04/01/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.17 / $3,911.87 / $12,812.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $35.17 / $35.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.79 / $32.63 / $37.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.36 / $700.46 / $1,005.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $33.75