Mogamulizumab injection, per 1 mg at Fairview Maple Grove Surgery Center

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Inj, mogamulizumab-kpkc, 1 mg

Maple Grove, MN

See all hospitals reporting HCPCS J9204 →

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $258 is 24% below the median hospital's median price ($338), higher than 26% of the 1,430 hospitals reporting HCPCS J9204. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J9204 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 6 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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#
1	Ucare mhcp fee schedule · both	$180	$180	—	—	—	$180 – $180
2	Medica accessability fee schedule · both	$188	$188	—	—	—	$188 – $188
3	Medica medicaid fee schedule · both	$188	$188	—	—	—	$188 – $188
4	Medicaid medicaid fee schedule · both	$200	$200	—	—	—	$200 – $200
5	Blue Cross Blue Shield medicaid fee schedule · both	$202	$202	—	—	—	$202 – $202
6	Blue Cross Blue Shield federal fee schedule · outpatient	$228	$228	—	—	—	$228 – $228
7	Blue Cross Blue Shield commercial fee schedule · outpatient	$233	$233	—	—	—	$233 – $233
8	Blue Cross Blue Shield medicaid fee schedule · outpatient	$233	$233	—	—	—	$233 – $233
9	UnitedHealthcare medicare advantage fee schedule · outpatient	$245	$245	—	—	—	$245 – $245
10	Blue Cross Blue Shield federal fee schedule · both	$246	$246	—	—	—	$246 – $246
11	Blue Cross Blue Shield commercial fee schedule · both	$250	$250	—	—	—	$250 – $250
12	Blue Cross Blue Shield medicare advantage fee schedule · outpatient	$254	$254	—	—	—	$254 – $254
13	Medica ma non-snp fee schedule · both	$258	$258	—	—	—	$258 – $258
14	Medica ma snp fee schedule · both	$258	$258	—	—	—	$258 – $258
15	Medica prime solution fee schedule · both	$258	$258	—	—	—	$258 – $258
16	Medica vantage fee schedule · both	$258	$258	—	—	—	$258 – $258
17	Cigna commercial fee schedule · both	$279	$279	$24	9%	—	$255 – $304
18	Ucare ifp with fairview fee schedule · outpatient	$422	$422	—	—	—	$422 – $422
19	UnitedHealthcare commercial fee schedule · both	$433	$433	—	—	—	$433 – $433
20	Cigna commercial fee schedule · outpatient	$437	$437	$38	9%	—	$399 – $475
21	Medica bold fee schedule · both	$442	$442	—	—	—	$442 – $442
22	Medica choice without / elect fee schedule · both	$491	$491	—	—	—	$491 – $491
23	Medica city of st paul / essential uplan fee schedule · both	$491	$491	—	—	—	$491 – $491
24	Medica choice with fee schedule · both	$508	$508	—	—	—	$508 – $508
25	Ucare ifp fee schedule · outpatient	$562	$562	—	—	—	$562 – $562

Last updated: May 18, 2026

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