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Pennsylvania 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
$1.10 / $1.86 / $2.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.58 / $3.47
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.23
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.79
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.23 / $1.23
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.12 / $1.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.86 / $2.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.38 / $3.47
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1,513.56 / $6,918.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.51 / $30.20
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.81 / $0.91
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.91 / $1.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.81 / $1.10