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Alaska rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,816.69 / $27,634.80 / $27,634.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,854.35 / $7,895.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $4,971.34
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $7,895.65 / $11,290.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,376.54 / $4,823.63 / $4,823.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $7,895.65 / $11,697.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,823.63 / $5,848.63 / $7,018.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,166.29 / $7,310.79 / $14,621.58