go back

Washington 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
$0.86 / $1.28 / $1.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.98
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $85.00 / $85.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.79 / $4.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.72 / $1.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.94
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.32 / $2.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.22 / $2.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.84 / $1.60
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.88 / $1.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.79 / $1.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.79 / $0.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.94
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75