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Washington 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
$0.55 / $98.74 / $389.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $22.50 / $288.27
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.37 / $95.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
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