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Louisiana rates for HCPCS J9204

Injection Mogamulizumab-Kpkc 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $320.57 / $700.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $300.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.72 / $194.44 / $267.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.99 / $267.99 / $273.35
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,274.86 / $30,274.86 / $30,274.86
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.65 / $248.50 / $286.02