go back

Oklahoma 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 / $2.44 / $4.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.40
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 / $2.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.44 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.25 / $2.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22