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Indiana 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
$2.24 / $5.25 / $10.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $3.39 / $4.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $4.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $3.31 / $4.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $6.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $4.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.75