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Utah 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
$8.77 / $9.11 / $9.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.11 / $9.11 / $9.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.74 / $9.90 / $11.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $7.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.05 / $14.66 / $19.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $7.85 / $8.74