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Tennessee 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
$0.96 / $0.99 / $1,370.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.78 / $0.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.79 / $0.88