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Rhode Island rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$807.63 / $807.63 / $807.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $260.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.90 / $248.50 / $262.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $276.63