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California rates for HCPCS Q5105

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.46 / $2.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.15 / $2.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.65
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.25 / $1.32
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.84 / $2.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.79 / $1.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.94
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.01 / $6.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.91 / $2.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.81 / $1.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.04
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.79 / $1.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.12