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Pennsylvania 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
$180.72 / $289.14 / $448.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $176.47 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.47 / $176.47 / $176.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.72 / $278.31 / $448.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $359.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.23 / $187.23 / $187.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.23 / $187.23 / $187.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $235.29