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Vermont rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.69 / $48.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $27.97 / $46.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $27.97 / $46.62
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $32.14 / $46.64