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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
$2.25 / $2.52 / $4.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $3.77 / $9.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $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
$2.33 / $3.61 / $6.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.41 / $2.65 / $3.37