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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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $3.09 / $3.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $4.27 / $7.94
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.29 / $2.29
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.24 / $2.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24