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Arizona rates for HCPCS J7204

Injection Factor Viii Antihemophilic Factor (Recombinant) (Esperoct) Glycopegylated-Exei Per Iu

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $4.44 / $6.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.73 / $6.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $7.41 / $12.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $2.18 / $14.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.23 / $2.99 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22