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Idaho 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
$132.04 / $132.04 / $8,007.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $143.47 / $163.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.73 / $123.73 / $131.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.27 / $173.79 / $234.45
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $144.28 / $163.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.56 / $141.22 / $264.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.54 / $157.38 / $157.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $146.01