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Rhode Island 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
$690.98 / $690.98 / $690.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.09 / $170.09 / $180.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.31 / $12.31 / $13.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $212.61