go back

Ohio 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 / $4.82 / $7.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.27 / $6.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $3.57 / $5.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $4.09
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $4.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.44 / $2.82 / $3.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.89