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Pennsylvania rates for HCPCS Q5125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.96 / $1.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.50
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.40 / $0.50
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.38 / $0.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.02 / $1.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.41 / $1.25
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.38 / $0.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.40 / $0.55