go back

Wisconsin rates for HCPCS J9225

Histrelin implant (Vantas), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,678.89 / $10,433.90 / $10,433.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,678.89 / $4,854.35 / $5,848.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,557.64 / $11,107.52 / $11,520.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,673.93 / $6,421.62 / $17,938.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $10,334.44 / $17,927.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $5,842.78 / $8,416.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,363.33 / $4,971.34 / $6,300.00
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.07 / $1,037.07 / $7,749.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,363.33 / $4,971.34 / $5,848.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $5,425.63 / $24,212.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,363.33 / $4,971.34 / $6,300.00
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.07 / $1,037.07 / $7,749.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,474.09 / $11,122.08 / $15,253.38
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,971.34 / $4,971.34 / $24,957.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,971.34 / $15,276.59 / $24,212.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,574.66 / $7,253.47 / $7,253.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,873.85 / $5,020.56 / $5,848.63