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Hawaii rates for HCPCS Q5122

Injection, pegfilgrastim-apgf (Nyvepria), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,482.44 / $5,482.44 / $5,482.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $136.44 / $2,056.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.83 / $170.83 / $213.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.27 / $157.38 / $183.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.41 / $146.01 / $196.74
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.55 / $150.94 / $421.13