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Oregon 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
$1.58 / $162.00 / $324.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.72 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.43 / $1.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.93 / $1.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.87 / $2.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.83 / $1.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.91 / $1.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.91