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Louisiana rates for HCPCS Q5122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.04 / $138.63 / $291.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $132.04 / $159.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.97 / $275.54 / $321.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.98 / $21.98 / $22.42
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $184.55