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Pennsylvania rates for HCPCS J9202

Goserelin acetate implant, per 3.6 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.00 / $1,717.91 / $3,975.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.66 / $741.00 / $1,063.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $733.67
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.51 / $795.96 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.35 / $761.35 / $761.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.14 / $733.67 / $733.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $761.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.35 / $1,348.74 / $1,348.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,079.77 / $1,881.45 / $2,551.40
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.90 / $763.90 / $763.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.49 / $1,600.45 / $3,785.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.66 / $741.49 / $1,319.41
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.39 / $346.10 / $1,222.09
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.14 / $733.67 / $733.67
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $761.57
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.92 / $567.92 / $659.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.92 / $567.92 / $659.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $777.69 / $1,098.84