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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
$2.22 / $2.33 / $4.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.25 / $2.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.72 / $2.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.33 / $2.33 / $2.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.20