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South Dakota rates for HCPCS Q5106

Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.85 / $7.85 / $7.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.92 / $9.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.20 / $7.85 / $9.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.83 / $12.79 / $20.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.43 / $7.87 / $8.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.48 / $11.21 / $13.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.48 / $9.68 / $22.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $8.36 / $8.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $7.85 / $8.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.57 / $7.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $7.57