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South Dakota rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,848.63 / $5,848.63 / $5,848.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,971.34 / $5,848.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,220.03 / $5,316.40 / $6,579.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,446.36 / $7,907.34 / $10,527.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $5,425.63 / $24,212.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,121.00 / $5,919.28 / $7,333.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,472.56 / $5,473.03 / $7,333.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $5,146.79 / $6,433.50