go back

New Hampshire 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 / $0.79 / $0.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $1.19 / $2.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.79 / $0.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Harvard Pilgrim
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 / $0.79 / $0.88
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.57 / $2.12