go back

North Dakota rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $447.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $300.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.60 / $270.95 / $274.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.96 / $270.95 / $274.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.21 / $248.50 / $315.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.71 / $258.44 / $447.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $276.63 / $1,074.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $295.72