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Wyoming 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 / $2.25 / $2.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $3.20 / $3.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22