HCPCS J9017
Injection, arsenic trioxide, 1 mg
Current codeChemotherapeutic Agent43 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $170 – $252 | — | — |
| Cascade Valley Hospital | $5.05 – $1,713 | $263 – $1,369 | $328 – $1,711 |
| Deaconess Medical Center | $155 – $165 | $5.78 – $30.44 | $14.44 – $76.10 |
| EvergreenHealth Medical Center | — | $1,224 | $1,530 |
| Harborview Medical Center | — | — | — |
| Highline Medical Center | — | $1,099 – $1,570 | $3,600 – $5,141 |
| Island Hospital | $160 – $174 | — | — |
| Kadlec Regional Medical Center | — | $1,090 – $3,931 | $1,557 – $5,615 |
| Legacy Salmon Creek Medical Center | — | — | — |
| Mary Bridge Children's Hospital | $161 – $174 | $68.04 – $239 | $170 – $597 |
| MultiCare Auburn Medical Center | $158 – $170 | — | — |
| MultiCare Covington Medical Center | $158 – $170 | — | — |
| MultiCare Good Samaritan Hospital | $161 – $174 | — | — |
| MultiCare Valley Hospital | $154 – $163 | — | — |
| Olympic Medical Center | $199 – $218 | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| PeaceHealth Peace Island Medical Center | — | $189 – $4,067 | $291 – $6,257 |
| PeaceHealth Southwest Medical Cente | — | $189 – $4,067 | $291 – $6,257 |
| PeaceHealth St John Medical Center | — | $189 – $4,067 | $291 – $6,257 |
| PeaceHealth St Joseph Medical Center | — | $189 – $4,067 | $291 – $6,257 |
| PeaceHealth United General Medical Center | — | $189 – $4,067 | $291 – $6,257 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $1,753 | $2,504 |
| Providence Centralia Hospital | — | — | — |
| Providence Holy Family Hospital | — | $1,753 | $2,504 |
| Providence Regional Medical Center Everett | — | $154 – $362 | $297 – $697 |
| Providence St Mary Medical Center | — | — | — |
| Providence St Peter Hospital | — | $29.17 – $640 | $56.10 – $1,232 |
| Seattle Children's Hospital | $154 – $195 | $600 | $600 |
| Skagit Valley Hospital | $1,225 | $263 – $1,369 | $328 – $1,711 |
| St Anthony Hospital | — | $1,095 – $1,564 | $3,600 – $5,141 |
| St Clare Hospital | — | $1,038 – $1,482 | $3,600 – $5,141 |
| St Elizabeth Hospital | $612 – $1,064 | $1,272 – $1,817 | $3,600 – $5,141 |
| St Francis Community Hospital | — | $1,130 – $1,613 | $3,600 – $5,141 |
| St Joseph Medical Center | — | $1,192 – $1,703 | $3,600 – $5,141 |
| St Michael Medical Center | — | $1,589 – $2,269 | $3,600 – $5,141 |
| Swedish Edmonds Hospital | — | $164 | $341 |
| Swedish Issaquah | — | $164 | $341 |
| Swedish Medical Center | — | $164 – $265 | $341 – $551 |
| Swedish Medical Center / Cherry Hill | — | $164 | $341 |
| Tacoma General Allenmore Hospital | $162 – $174 | — | — |
| University of Washington Medical Ctr | — | — | — |
| Virginia Mason Medical Center | — | $9.59 | $18.81 |
| Yakima Valley Memorial | $154 – $179 | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.