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New Hampshire 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
$2.24 / $2.51 / $4.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $3.31 / $4.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.24 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $3.72 / $4.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.39