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Montana rates for HCPCS J7204

Injection Factor Viii Antihemophilic Factor (Recombinant) (Esperoct) Glycopegylated-Exei Per Iu

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.73 / $6.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.42 / $3.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22