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Indiana rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.98 / $573.24 / $1,720.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $273.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $497.00 / $601.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $342.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $372.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $310.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $281.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.34 / $248.34 / $248.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $263.41 / $284.93