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Virginia rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.84 / $58.78 / $3,882.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $31.84 / $33.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $63.98 / $103.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
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 / $30.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.77 / $36.38 / $392.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $30.32 / $48.49
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.80 / $36.69 / $372.92
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $36.69 / $372.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $32.14 / $39.42