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Oregon rates for HCPCS J1050

Injection Medroxyprogesterone Acetate 1 Mg (Reinstated) Injection Medroxyprogesterone Acetate 100 Mg Special Coverage Instructions Apply. See Mcm: 2049) (Old Description - Deleted 06/30/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $1.30 / $247.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $90.75 / $240.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.77 / $1.15
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.60 / $1.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.34 / $0.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48