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South Carolina rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45,708.82 / $63,095.73 / $181,970.09
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
$13,182.57 / $40,738.03 / $57,543.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40,738.03 / $51,286.14 / $61,659.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,738.03 / $43,651.58 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $46,773.51
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,791.08 / $17,378.01 / $22,387.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,952.62 / $44,668.36 / $74,131.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $107,151.93 / $112,201.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $45,708.82 / $93,325.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37,153.52 / $45,708.82 / $47,863.01