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Oklahoma rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.93 / $268.38 / $378.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $253.47 / $300.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.70 / $193.56 / $306.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $234.43 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.87 / $268.38 / $375.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.17 / $248.50 / $312.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.34 / $248.34 / $248.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.08 / $248.50 / $285.77