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South 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
$2.00 / $3.09 / $9.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $3.02 / $5.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.75 / $3.55
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 / $2.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.82 / $6.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.24 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.45