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Iowa 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
$2.25 / $4.93 / $8.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $6.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.18 / $2.72
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $4.01 / $49.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.45 / $3.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $3.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $3.29 / $5.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.71 / $3.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.25
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25