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Utah rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.26 / $288.26 / $288.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $250.98 / $310.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.63 / $342.41 / $369.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $248.50 / $328.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.28 / $481.83 / $691.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.35 / $336.82 / $354.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $248.50