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Pennsylvania 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
$2.22 / $5.29 / $6.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.25 / $6.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.41 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.31
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $5.29 / $6.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.27 / $6.87
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.22 / $2.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.37
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $3.07