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Montana rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $53,703.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,481.34 / $70,794.58 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54,954.09 / $54,954.09 / $114,815.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $56,234.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $46,773.51 / $100,000.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $46,773.51 / $100,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $43,651.58 / $74,131.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $54,954.09 / $58,884.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $45,708.82