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North Carolina 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
$2.04 / $2.69 / $4.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $6.17 / $7.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.24 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.45 / $2.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $3.55 / $3.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.88
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11