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New York 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 / $170.09 / $255.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.69 / $170.09 / $180.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.00 / $225.00 / $347.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.71 / $191.28 / $191.28
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.35 / $191.35 / $309.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.95 / $86.20 / $226.56
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.71 / $191.28 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $270.45
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72