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Maine rates for HCPCS J9219

Leuprolide acetate implant, 65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,182.00 / $11,182.00 / $12,049.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,952.25 / $4,096.85 / $4,819.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,182.00 / $11,182.00 / $12,049.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,952.25 / $4,096.85 / $4,819.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,831.39 / $5,684.00 / $8,241.79