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Wisconsin rates for HCPCS J9219

Leuprolide acetate implant, 65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,855.86 / $8,598.57 / $8,598.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $3,991.77 / $4,819.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $6,844.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $9,820.02 / $17,035.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $6,252.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,855.86 / $4,096.85 / $4,895.62
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.29 / $1,203.29 / $7,229.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,855.86 / $4,096.85 / $4,895.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $6,252.40 / $7,389.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,855.86 / $4,096.85 / $4,937.27
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.29 / $1,203.29 / $7,229.73
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $21,887.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,831.39 / $6,113.17 / $8,833.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $5,855.09 / $6,763.96