go back

South Dakota rates for HCPCS Q5105

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.79 / $0.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $1.28 / $1.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $4.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $1.09 / $1.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.91 / $1.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.84 / $0.94
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76