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Wisconsin rates for HCPCS Q5125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.82 / $0.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $1.15 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.85 / $0.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.41 / $0.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.46 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $1.05 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.41 / $0.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.50 / $1.37
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.38 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.42 / $0.56