go back

Wisconsin 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
$0.81 / $1.74 / $1.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $1.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.18 / $2.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $1.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.79 / $0.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $4.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.79 / $0.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.10 / $2.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $65.00 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.38 / $4.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.83 / $1.00