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Pennsylvania rates for HCPCS Q5106

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.80 / $17.71 / $23.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $8.16 / $502.43
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.11 / $8.36 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.21 / $7.85 / $7.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $7.85
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.74 / $20.74 / $20.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.64 / $17.71 / $23.01
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.64 / $9.16 / $502.43
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.21 / $7.85 / $7.85
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $7.85
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.06 / $8.06 / $9.36
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.06 / $8.06 / $9.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $8.40 / $13.53