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Louisiana rates for HCPCS J1620

Injection Gonadorelin Hydrochloride Per 100 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.61 / $212.61 / $297.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.61 / $212.61 / $212.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.98 / $201.98 / $302.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.98 / $201.98 / $206.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $212.61