go back

Wisconsin rates for HCPCS J9226

Histrelin implant (Supprelin LA), 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,668.36 / $64,565.42 / $128,824.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $58,884.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53,703.18 / $53,703.18 / $95,499.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $61,659.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $69,183.10 / $162,181.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $44,668.36 / $87,096.36
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,738.03 / $44,668.36 / $52,480.75
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $89,125.09 / $112,201.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,738.03 / $45,708.82 / $60,255.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45,708.82 / $51,286.14 / $199,526.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $67,608.30 / $134,896.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $43,651.58 / $223,872.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $83,176.38 / $199,526.23
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35,481.34 / $51,286.14 / $67,608.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $45,708.82 / $45,708.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,651.58 / $45,708.82 / $51,286.14