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Idaho 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 / $2.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.45 / $2.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $2.95 / $3.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $3.26 / $5.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22