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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
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $10.00 / $11.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $16.98 / $28.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $13.18
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.76 / $9.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.51