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Maine rates for HCPCS Q5122

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $136.40 / $180.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.92 / $159.32 / $415.65
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
$117.01 / $131.16 / $131.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $158.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $143.47 / $180.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $229.53