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Wisconsin rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Facilitymedian $275 · 10th–90th $251–$7590%20%40%10th90th$275Professionalmedian $251 · 10th–90th $251–$4270%50%90th$251$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $380.19 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $275.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $562.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $501.19 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $302.00 / $512.86
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $275.42
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $501.19 / $562.34
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $275.42 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $245.47 / $257.04
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $257.04 / $436.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $407.38 / $812.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $371.54 / $1,230.27
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $416.87 / $1,071.52
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $338.84 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $575.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $251.19 / $288.40