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Arizona 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
$0.85 / $1.17 / $2.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $1.03 / $1.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.76 / $0.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.79 / $0.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.83 / $1.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.84