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New Hampshire rates for HCPCS J9204

Injection Mogamulizumab-Kpkc 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $298.20 / $305.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $258.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.08 / $447.30 / $1,086.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $248.50 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $416.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $263.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.22 / $229.04 / $291.51