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New Hampshire rates for HCPCS J9219

Leuprolide acetate implant, 65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,096.85 / $4,588.47 / $5,041.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,325.68 / $4,096.85 / $4,096.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
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 / $8,076.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,831.39 / $5,684.00 / $6,025.04
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $5,301.80 / $6,747.75