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Connecticut rates for HCPCS Q5122

Injection Pegfilgrastim-Apgf (Nyvepria) Biosimilar 0.5 Mg (Desc Revised 04/01/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.40 / $210.54 / $366.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.40 / $136.40 / $136.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.06 / $199.39 / $393.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.71 / $145.02 / $167.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.04 / $138.71 / $361.10