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Nebraska rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $549.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $417.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.15 / $269.58 / $269.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.51 / $304.75 / $304.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.00 / $233.00 / $233.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $335.06 / $375.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.17 / $360.33 / $497.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.63 / $271.20 / $372.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.35 / $365.44 / $491.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.35 / $365.44 / $512.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.74 / $349.40 / $517.07
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 / $248.50 / $295.72