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New Hampshire 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 / $132.04 / $264.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.15 / $131.16 / $132.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.33 / $236.09 / $594.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $132.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.73 / $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
$137.61 / $213.00 / $404.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $139.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.99 / $459.07 / $3,000.00