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Washington rates for HCPCS Q4081

Injection, epoetin alfa, 100 units (for ESRD on dialysis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $1.54 / $1.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.86 / $1.02
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.94 / $1,342.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.81 / $0.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.85 / $1.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $1.27 / $2.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.12 / $2.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $0.85 / $1.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.98 / $1.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $0.94 / $0.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.94 / $1.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.65