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New York 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 / $2.76 / $4.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $1.78 / $2.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.22 / $2.22
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $2.18 / $2.29
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.18 / $2.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $3.15 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.41 / $2.41 / $3.39
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.31
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.22 / $3.20
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.31
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.31