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Maryland 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
$2.25 / $2.25 / $2.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.66
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.19