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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
$7.08 / $7.59 / $34.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $15.85 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $8.91 / $22.39
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $8.91 / $22.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $10.72 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59