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Washington rates for HCPCS Q5120

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.36 / $3,854.51 / $8,360.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $33.36 / $1,667.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.29 / $520.14 / $970.91
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.44 / $33.35 / $392.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.58 / $24.71 / $30.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $30.65
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.47 / $30.05 / $57.30
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.86 / $530.54 / $970.91
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.24 / $28.44 / $392.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.35 / $349.01 / $790.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.35 / $33.35 / $33.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $36.38