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Nebraska 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
$170.09 / $408.66 / $469.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.09 / $170.09 / $285.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.08 / $204.11 / $204.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.90 / $202.06 / $204.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.38 / $186.38 / $232.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.61 / $212.61 / $323.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $212.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.71 / $224.71 / $332.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.71 / $332.51 / $332.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.29 / $180.30 / $198.33