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Montana rates for HCPCS J9203

Injection, gemtuzumab ozogamicin, 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $257.91 / $295.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.38 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.67 / $281.67 / $605.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $236.62 / $281.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.62 / $281.67 / $348.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $281.67 / $301.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $236.62 / $236.62