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Hawaii rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,332.60 / $10,332.60 / $10,332.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,854.35 / $4,971.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,332.58 / $10,332.58 / $10,332.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $5,967.07
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,837.91 / $5,837.91 / $5,837.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $670.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,830.47 / $4,873.85 / $7,310.79
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,826.52 / $4,107.54 / $5,413.32