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South Carolina rates for HCPCS J9203

Injection, gemtuzumab ozogamicin, 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.74 / $248.45 / $1,004.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.49 / $236.62 / $248.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.11 / $249.35 / $418.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $258.29 / $313.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.22 / $236.62 / $279.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.62 / $236.62 / $251.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.16 / $236.62 / $384.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.16 / $193.16 / $369.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.77 / $248.45 / $303.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.13 / $250.82 / $274.48