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Montana rates for HCPCS J9202

Goserelin acetate implant, per 3.6 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,900.00 / $1,900.00 / $1,900.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.66 / $741.49 / $1,551.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.85 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.30 / $864.80 / $1,490.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $864.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.22 / $733.67 / $887.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $843.46 / $934.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $733.67