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Connecticut rates for HCPCS J7298

Levonorgestrel-Releasing Intrauterine Contraceptive System (Mirena) 52 Mg (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.63 / $1,862.27 / $3,938.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,214.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,303.42 / $2,034.51 / $3,640.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,238.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,238.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,238.93
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,457.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.17 / $1,214.63 / $1,340.96