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Rhode Island rates for HCPCS Q5122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.27 / $426.27 / $426.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $132.46 / $136.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.04 / $132.04 / $333.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $131.16 / $146.01