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Nebraska 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 / $4.26 / $4.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $6.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $2.39 / $2.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.49 / $2.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.22 / $2.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.25 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.25 / $2.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $3.43 / $5.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.71 / $5.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.22 / $2.44