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Alaska 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
$2.29 / $4.17 / $14.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $4.13 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.91 / $5.91 / $5.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $7.15
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.30 / $4.28 / $6.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.28 / $5.91 / $10.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $3.33 / $4.48