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Maine rates for HCPCS J3315

Injection, triptorelin pamoate, 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,101.63 / $1,101.63 / $1,187.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.83 / $493.83 / $595.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.50 / $576.79 / $1,504.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $474.84 / $474.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.84 / $474.84 / $481.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $474.84 / $474.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $474.84 / $575.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,101.63 / $1,101.63 / $1,187.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.83 / $493.83 / $1,187.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.24 / $474.84 / $712.26