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Virginia 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 / $2.59 / $5.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.33 / $2.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $4.68 / $7.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.97 / $3.38 / $5.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.66 / $3.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.55
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.29 / $3.04
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.29 / $3.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $2.22 / $2.79