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Maryland 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 / $0.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.86
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.79 / $1.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.88 / $0.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $1.03