go back

Montana rates for HCPCS Q5125

Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,067.00 / $1,067.00 / $1,067.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.41 / $0.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.40 / $0.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38