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South Carolina 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
$3,952.25 / $3,952.25 / $15,978.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $3,952.25 / $4,096.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,485.04 / $8,990.85 / $15,598.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,202.00 / $5,561.79 / $6,896.08
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 / $5,229.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,952.25 / $5,399.80 / $6,355.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,940.00 / $5,940.00 / $5,940.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,831.39 / $6,025.04 / $6,623.85