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.
Original text from hospital filings
GEMTUZUMAB OZOGAMICIN 4.5 MG/4.5ML IV (WET VIAL)
Low
$128
Average
$9.1k
Median
$240
High
$54.4k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
92 hospitals; the 90th percentile is 174.6× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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100 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $50.4k | $50.4k | — | — | — | $50.4k – $50.4k |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $237 | $237 | — | — | — | $237 – $237 |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 6 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $15.4k | $15.4k | — | — | — | $15.4k – $15.4k |
| 7 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $237 | $237 | — | — | — | $237 – $237 |
| 8 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 9 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 10 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $44.1k | $44.1k | — | — | — | $44.1k – $44.1k |
| 11 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $44.1k | $44.1k | — | — | — | $44.1k – $44.1k |
| 12 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $43.1k | $43.1k | — | — | — | $43.1k – $43.1k |
| 13 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $36.6k | $36.6k | — | — | — | $36.6k – $36.6k |
| 14 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 15 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 16 | Jefferson Health - Northeast Langhorne, PA facility · fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 17 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · inpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 18 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 19 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · inpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 20 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 21 | KARMANOS CANCER CENTER DETROIT, MI fee schedule | 1 | $209 | $209 | — | — | — | $209 – $209 |
| 22 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 23 | Kennedy University Hospital, Inc Turnersville, NJ facility · fee schedule · inpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 24 | Kennedy University Hospital, Inc Turnersville, NJ facility · fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 25 | Kennedy University Hospital, Inc Cherry Hill, NJ facility · fee schedule · inpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
← Payers reporting HCPCS J9203 · Snapshot 20261111T120946Z-9134e7f7