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Louisiana 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
$2.00 / $2.34 / $5.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.09 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.88