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Maine 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
$5.15 / $5.15 / $5.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.73 / $2.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $2.70 / $7.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.69
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.15 / $5.15 / $5.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.73 / $5.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.33