HCPCS J9204
Injection, mogamulizumab-kpkc, 1 mg
Current codeChemotherapeutic Agent40 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $4,427 – $6,559 | — | — |
| Deaconess Medical Center | $4,051 – $4,289 | $386 | $966 |
| Harborview Medical Center | — | — | — |
| Highline Medical Center | — | $8,932 – $42,515 | $29,250 – $139,230 |
| Island Hospital | $4,179 – $4,534 | — | — |
| Kadlec Regional Medical Center | — | — | — |
| Legacy Salmon Creek Medical Center | — | — | — |
| Mary Bridge Children's Hospital | $4,190 – $4,525 | — | — |
| MultiCare Auburn Medical Center | $4,114 – $4,443 | — | — |
| MultiCare Covington Medical Center | $4,114 – $4,443 | — | — |
| MultiCare Good Samaritan Hospital | $4,209 – $4,546 | — | — |
| MultiCare Valley Hospital | $4,022 – $4,258 | — | — |
| Olympic Medical Center | $5,178 – $5,671 | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| PeaceHealth Peace Island Medical Center | — | $7,004 | $10,776 |
| PeaceHealth Southwest Medical Cente | $264 | $7,004 | $10,776 |
| PeaceHealth St John Medical Center | $198 – $266 | $7,004 | $10,776 |
| PeaceHealth St Joseph Medical Center | $266 | $7,004 | $10,776 |
| PeaceHealth United General Medical Center | — | $7,004 | $10,776 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | — | — |
| Providence Centralia Hospital | — | — | — |
| Providence Holy Family Hospital | — | — | — |
| Providence Regional Medical Center Everett | — | — | — |
| Providence St Mary Medical Center | — | $16,449 | $23,498 |
| Providence St Peter Hospital | — | — | — |
| St Anthony Hospital | — | $8,896 – $42,347 | $29,250 – $139,230 |
| St Clare Hospital | — | $8,431 – $40,132 | $29,250 – $139,230 |
| St Elizabeth Hospital | $4,973 – $28,821 | $10,336 – $49,199 | $29,250 – $139,230 |
| St Francis Community Hospital | — | $9,179 – $43,694 | $29,250 – $139,230 |
| St Joseph Medical Center | — | $9,688 – $46,113 | $29,250 – $139,230 |
| St Michael Medical Center | — | $12,909 – $61,449 | $29,250 – $139,230 |
| Swedish Edmonds Hospital | — | $11,752 | $24,483 |
| Swedish Issaquah | — | $11,752 | $24,483 |
| Swedish Medical Center | — | $11,752 | $24,483 |
| Swedish Medical Center / Cherry Hill | — | $11,752 | $24,483 |
| Tacoma General Allenmore Hospital | $4,211 – $4,547 | — | — |
| University of Washington Medical Ctr | — | — | — |
| Virginia Mason Medical Center | — | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $4,023 – $4,674 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Hospital outpatient payment (national)
- $259 (APC 9182)
- Surgery center payment (national)
- $259