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Rhode Island 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
$15,664.40 / $15,664.40 / $15,664.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $4,096.85 / $4,096.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,793.11 / $9,793.11 / $10,881.23
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 / $5,301.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $5,684.00 / $6,025.04