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Maine rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,568.80 / $13,568.80 / $14,621.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,795.88 / $4,971.34 / $5,848.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,594.89 / $5,743.36 / $16,371.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $5,166.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $5,244.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $4,971.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,166.29 / $5,166.29 / $5,166.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,568.80 / $13,568.80 / $14,621.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,795.88 / $4,971.34 / $5,848.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $4,873.85 / $7,067.10