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Utah rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $93,325.43 / $95,499.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52,480.75 / $64,565.42 / $69,183.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $44,668.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30,199.52 / $44,668.36 / $58,884.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69,183.10 / $75,857.76 / $87,096.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47,863.01 / $47,863.01 / $63,095.73
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,018.94 / $42,657.95 / $42,657.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40,738.03 / $44,668.36 / $53,703.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $43,651.58