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Montana rates for HCPCS J9219

Leuprolide acetate implant, 65 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,981.07 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $5,623.41
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $5,623.41
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $5,623.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,786.30 / $7,244.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $4,786.30 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41