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Oregon rates for HCPCS J9219

Leuprolide Acetate Implant 65 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $9,639.64 / $9,639.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $4,000.45 / $4,819.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $9,639.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $5,456.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $178.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.45 / $4,819.82 / $10,299.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,972.10 / $4,819.82 / $13,910.16
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.45 / $4,819.82 / $10,299.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $2,250,000.00 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.50 / $820.50 / $820.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $5,684.00 / $6,536.60