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Montana rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Facilitymedian $275 · 10th–90th $245–$4680%20%40%10th90th$275Professionalmedian $251 · 10th–90th $251–$3240%50%90th$251$100.0$500.0$2.0K$10.0K$50.0K$200.0K$1.0M

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $257.04 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $302.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $245.47 / $457.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $245.47 / $457.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $288.40 / $489.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $302.00 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $251.19 / $263.03