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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
$251.19 / $251.19 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $281.84 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $281.84
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $251.19 / $288.40