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New Hampshire rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $47,863.01 / $87,096.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $51,286.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51,286.14 / $64,565.42 / $91,201.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $46,773.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,738.03 / $43,651.58 / $43,651.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $43,651.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40,738.03 / $40,738.03 / $47,863.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41,686.94 / $43,651.58 / $47,863.01
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51,286.14 / $69,183.10 / $85,113.80