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Vermont rates for HCPCS J9203

Injection, gemtuzumab ozogamicin, 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $269.15 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $269.15
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $239.88 / $269.15