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Montana rates for HCPCS J9217

Leuprolide acetate (for depot suspension), 7.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.77 / $2,091.38 / $10,027.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $505.05 / $1,854.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.12 / $68,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.00 / $801.00 / $801.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.30 / $211.30 / $608.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $218.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.45 / $213.50 / $493.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.36 / $211.81 / $225.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $176.45