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Nebraska rates for HCPCS J7298

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.63 / $2,596.00 / $3,988.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$930.00 / $1,214.63 / $2,220.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$885.00 / $885.00 / $885.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.80 / $1,238.93 / $1,446.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.04 / $2,277.05 / $5,205.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,457.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.61 / $1,176.61 / $1,327.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.56 / $1,327.56 / $1,327.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,153.90 / $1,214.63 / $1,336.09