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Washington rates for HCPCS J2504

Injection, pegademase bovine, 25 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.08 / $641.13 / $870.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.74 / $354.08 / $414.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.89 / $303.47 / $525.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.56 / $416.56 / $607.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.96 / $367.96 / $1,471.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.96 / $367.96 / $451.27
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.89 / $238.67 / $517.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.54 / $357.54 / $357.54