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Montana rates for HCPCS Q5106

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 units

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.84 / $7.92 / $29.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.46 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $8.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $8.52 / $11.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $7.85