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Utah rates for HCPCS J7170

Injection, emicizumab-kxwh, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $74.13 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $102.33 / $190.55
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $58.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $56.23 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23