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Montana rates for HCPCS Q5122

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $132.46 / $159.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.96 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.25 / $153.25 / $153.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $153.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.25 / $153.25 / $153.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.86 / $142.29 / $185.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16