Drugs (Administered) · J7205 · Drug
Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu
What Medicare pays for J7205, what providers bill, and how the price varies across 2 states, drawn from CMS 2023 claims data.
- $1.88
- Medicare pays
- $3.71
- Providers bill
- 2.0×
- Markup
- #44 of 9,297
- Volume rank
The verdict
Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu posts top-1% national service volume.
- Top 1%
- national service volume
- $1.88
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Drugs (Administered), the applied ratio is 2.24x Medicare (RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
What the billed charge breaks down into
$3.71
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Pennsylvania | $1.70 | $3.07 |
| California | $1.69 | $3.40 |
What the Data Says About Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu
Across 2 states with reporting providers, CPT code J7205 (Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu) shows a national average Medicare payment of $1.88 against an average billed charge of $3.71. That gap, a 2.0x markup, or 97% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Drugs (Administered) procedures like this one saw 16.7M services billed to Medicare in 2023 by 60 distinct providers, serving 104 unique beneficiaries. State-level variation is significant: California reports the lowest average payment at $1.69, while Pennsylvania reports the highest at $1.70. At just 1%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.24x Medicare; RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline), the estimated commercial insurance price lands near $5.30, with self-pay cash discounts commonly bringing the figure closer to $2.79. Within Drugs (Administered), Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu ranks #390 of 530 tracked procedures by national average Medicare payment.
Where this sits in the registry
Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu (J7205) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Drugs (Administered) codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu rank among Medicare procedures?
According to CMS Medicare Part B claims, Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu (CPT J7205) ranks #44 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #390 of 530 within Drugs (Administered) by national average Medicare payment. See /methodology#corpus-placement.
How much does Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu cost?
Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu (CPT J7205) is priced fairly consistently nationwide: Medicare pays $1.88 on average, and the $1.69-$1.70 state range stays relatively tight. Providers typically bill $3.71.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu cost with insurance?
With commercial insurance, injection, factor viii fc fusion protein (recombinant), per iu costs an estimated $5.30 on average (range: $3.71-$7.42), a moderate premium over Medicare's $1.88. Without insurance, the estimated cash price is $2.79.
Which state has the lowest cost for Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu?
California and Pennsylvania bookend the range for Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu, at $1.69 and $1.70 respectively - a relatively tight $0.01 spread nationwide.
How many providers perform Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu?
Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu is comparatively uncommon: only 60 providers nationally billed Medicare for it in 2023, serving 104 beneficiaries via 16.7M total services.
What is the billed-to-Medicare markup for Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu?
Providers bill 2.0x what Medicare pays for Injection, Factor Viii Fc Fusion Protein (recombinant), Per Iu - a markup within the typical range at 97% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (16.7M here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.