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Illinois 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 / $1.10 / $3,415.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.30 / $2.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $1.09 / $1.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.12 / $1.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.97
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.64 / $2.86
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.97 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.84 / $0.94