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Utah rates for HCPCS Q5105

Injection Epoetin Alfa-Epbx Biosimilar (Retacrit) (For Esrd On Dialysis) 100 Units (Desc Rvsd 1/1/20)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.81 / $0.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.91 / $1.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.94 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79