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Michigan rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.95 / $332.74 / $497.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $250.98 / $273.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.68 / $541.98 / $1,032.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.52 / $263.31 / $341.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $293.04
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $447.91 / $712.18
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $255.95 / $310.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.63 / $267.99 / $365.44
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 / $276.63 / $300.69