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Illinois 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 / $3.39 / $5.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.25 / $2.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.85 / $8.93 / $44.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $3.33 / $55.70
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $2.89 / $2.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.72