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Hawaii 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
$4.20 / $4.20 / $4.20
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
$2.45 / $2.67 / $3.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.33
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.54 / $2.83