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South Carolina 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
$137.72 / $137.72 / $560.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.31 / $132.46 / $180.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.31 / $404.07 / $582.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.40 / $318.97 / $407.20
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.72 / $165.26 / $392.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.00 / $471.00 / $471.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $139.03 / $146.01