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South Carolina rates for HCPCS J9204

Injection Mogamulizumab-Kpkc 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.92 / $260.92 / $1,054.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.26 / $248.50 / $270.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.41 / $244.73 / $403.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $272.58 / $331.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $248.50 / $291.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $257.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.87 / $248.50 / $401.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.87 / $200.87 / $372.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.46 / $251.29 / $586.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.34 / $248.34 / $248.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.23 / $263.41 / $298.20