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Maine rates for HCPCS J7298

Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,236.23 / $3,381.54 / $4,763.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,336.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,755.51 / $3,755.51 / $3,755.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.92 / $1,238.92 / $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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,500.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,307.70 / $3,381.54 / $4,620.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,755.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,821.95