go back

South Dakota rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $52,480.75 / $125,892.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $74,131.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $54,954.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,810.72 / $45,708.82 / $91,201.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45,708.82 / $51,286.14 / $199,526.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53,703.18 / $58,884.37 / $67,608.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45,708.82 / $45,708.82 / $45,708.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46,773.51 / $46,773.51 / $46,773.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $47,863.01 / $51,286.14
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,977.88 / $48,977.88 / $48,977.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48,977.88 / $48,977.88 / $48,977.88