go back

Maine rates for HCPCS J9217

Leuprolide acetate (for depot suspension), 7.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.36 / $3,065.69 / $6,502.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.44 / $183.50 / $257.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.93 / $196.16 / $559.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $183.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.45 / $176.45 / $460.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $176.45
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.17 / $263.17 / $263.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $176.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.36 / $1,164.78 / $7,297.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $183.57 / $357.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $255.85