What do doctors typically charge for Injection Pegfilgrastim-pbbk Fylnetra Biosimilar 0 5 Mg?

The nationwide median physician charge for Injection Pegfilgrastim-pbbk Fylnetra Biosimilar 0 5 Mg (HCPCS Q5130) is $730.80. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for HCPCS Q5130?

The standard insurance baseline reimbursement rate is $205.46. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Injection Pegfilgrastim-pbbk Fylnetra Biosimilar 0 5 Mg

HCPCS Q5130Medical Service

Injection Pegfilgrastim-pbbk Fylnetra Biosimilar 0 5 Mg

Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg. Clinical pricing breakdown and utilization metrics across 4 practicing doctors nationwide.

$730.80

Peer Median Charge

Gross billed rate

$205.46

Standard Baseline

Customary allowable

3.6x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT Q5130?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $730.80. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $205.46 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code Q5130 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"