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Arizona rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $467.74 / $50,118.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $257.04 / $338.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $524.81 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $281.84 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $281.84 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $251.19 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $251.19 / $281.84