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West Virginia rates for HCPCS J9204

Injection, mogamulizumab-kpkc, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $250.98 / $273.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $260.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.50 / $273.35 / $372.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $576.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $243.63 / $248.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $248.50 / $257.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.50 / $273.35 / $286.94