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Maine 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
$493.26 / $493.26 / $531.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $198.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.26 / $493.26 / $531.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $531.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $261.44