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Indiana rates for HCPCS J2504

Injection, pegademase bovine, 25 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $333.25 / $1,499.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.25 / $333.25 / $333.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $735.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.76 / $367.96 / $496.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.56 / $142.56 / $185.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.00 / $142.56 / $228.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.96 / $367.96 / $937.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.96 / $367.96 / $1,011.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.54 / $357.54 / $416.56