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North Dakota 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
$2.00 / $2.00 / $4.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.45 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $3.31 / $6.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.24 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.24 / $2.51