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Virginia 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
$1.02 / $1.32 / $3.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.15
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.76 / $1.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.85 / $1.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.26
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.00 / $1.26
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.00 / $1.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.81 / $0.89