go back

South Carolina 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
$1.32 / $1.32 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.25 / $1.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.19 / $1.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.90 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.13 / $1.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.13 / $1.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.89 / $1.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.84 / $0.91