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Vermont rates for HCPCS J9204

Injection Mogamulizumab-Kpkc 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $534.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.32 / $281.32 / $281.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $275.80 / $459.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $459.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $275.80 / $459.67
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $459.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.90 / $263.41 / $575.10