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Montana rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $270.86 / $310.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.77 / $298.77 / $600.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $298.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $298.77 / $345.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $298.56 / $316.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50