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Montana rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,854.35 / $11,942.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,395.04 / $7,413.78 / $7,413.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $7,413.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,125.88 / $5,166.29 / $7,413.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $6,092.33 / $7,413.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $4,873.85 / $4,873.85