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Pennsylvania rates for HCPCS Q5122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.16 / $308.97 / $401.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $133.36 / $2,056.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.95 / $142.29 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.11 / $136.11 / $136.11
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.00 / $192.32 / $342.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.36 / $327.45 / $401.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $143.47 / $1,556.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.73 / $131.16 / $131.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.65 / $146.65 / $170.17
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.65 / $146.65 / $170.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $141.65 / $226.05