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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
$0.71 / $1.12 / $373.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $2.60 / $5.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.14 / $105.14 / $105.14
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 / $85.00 / $85.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.81 / $0.99
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,273.11 / $7,273.11 / $7,273.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.82 / $1.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $2.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.84 / $0.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.79 / $1.07