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
$2.00 / $2.40 / $4.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.09 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.45 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.24