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Idaho rates for HCPCS J9202

Goserelin acetate implant, per 3.6 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.15 / $3,789.24 / $4,164.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.66 / $763.31 / $1,551.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.14 / $692.14 / $733.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $733.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.00 / $741.00 / $1,058.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $777.68 / $917.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.89 / $705.14 / $1,375.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.53 / $951.03 / $1,648.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.40 / $880.40 / $917.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $777.69