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Idaho 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
$0.76 / $0.76 / $0.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.82 / $0.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.98 / $1.45
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.95 / $0.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.70 / $30.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $0.92 / $1.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $0.94 / $0.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.84