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Maine 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
$0.81 / $0.81 / $1.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.82 / $0.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.98 / $1.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.98 / $1.98 / $1.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.82 / $1.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.14