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Maine rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.52 / $576.52 / $621.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $258.44 / $300.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.02 / $276.26 / $787.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $257.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.32 / $248.50 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.52 / $576.52 / $621.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $260.92 / $417.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $360.33