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Rhode Island rates for HCPCS Q5125

Injection Filgrastim-Ayow Biosimilar (Releuko) 1 Microgram

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.24 / $1.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.41 / $0.54
BCBS
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.42