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Alaska 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
$4.94 / $4.94 / $4.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.85 / $1.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $1.46 / $2.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.98 / $1.98
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.46 / $2.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.92 / $1.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.19 / $2.25