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Oregon rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $295.54 / $497.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $250.98 / $427.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $413.17 / $487.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $281.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.48 / $545.21 / $666.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $260.93 / $534.28
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $263.41 / $323.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $310.63 / $745.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $284.18 / $498.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $284.18 / $316.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.25 / $366.14 / $828.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $273.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $285.77