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Indiana rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,678.89 / $10,820.00 / $21,055.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,678.89 / $4,971.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $10,332.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $5,166.29 / $6,974.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,626.91 / $5,046.13 / $6,908.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,205.10 / $5,046.13 / $6,307.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $4,971.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $5,667.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $5,166.29 / $5,588.40