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Massachusetts 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 / $2.22 / $4.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.31 / $2.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $5.95 / $85.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.83 / $6.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $4.61
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.11