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Texas 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
$1.12 / $89.13 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.51 / $4.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $2.51 / $4.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
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 / $0.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $85.11 / $85.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $4.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.83 / $1.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $158.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.17
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,265.80 / $6,918.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.82 / $30.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.81 / $0.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.95