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Utah 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
$2.58 / $2.58 / $2.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $2.58 / $2.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $3.04 / $3.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.40 / $4.38 / $6.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.22 / $2.22