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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
$2.25 / $5.21 / $10.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.25 / $2.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $4.44 / $5.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $2.22 / $3.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.44 / $3.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.22 / $5.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.78