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Montana rates for HCPCS Q5105

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $436.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $64,999.99 / $68,099.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.81 / $0.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.81 / $1.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.92 / $1.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79