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Vermont 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
$2.22 / $2.22 / $3.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $2.52 / $2.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.42 / $4.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.42 / $4.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.22 / $3.42