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West Virginia 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 / $0.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.84 / $1.13