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Idaho rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $285.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $255.95 / $310.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $234.43 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $310.62 / $397.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $263.41 / $310.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.14 / $218.99 / $475.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.38 / $351.40 / $596.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.20 / $298.20 / $310.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $263.41