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Washington 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
$2.29 / $2.84 / $4.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.45 / $2.73
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $3.26 / $6.73
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.58 / $3.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $4.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.73
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.78 / $6.66
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.87 / $3.32 / $5.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.37 / $3.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.74 / $6.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22