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Maine rates for HCPCS J9202

Goserelin acetate implant, per 3.6 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,949.84 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,047.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $912.01 / $2,454.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $794.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,949.84 / $4,168.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $794.33 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $933.25