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Arkansas rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.77 / $298.20 / $313.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $260.92 / $298.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.58 / $269.58 / $269.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.82 / $269.58 / $269.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.75 / $243.32 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $269.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.08 / $248.50 / $285.77