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Texas 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 / $3.59 / $4.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.25 / $3.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $5.62 / $10.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $3.17 / $3.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $2.22 / $4.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.22 / $3.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.22 / $3.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $3.00