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Arizona rates for HCPCS J1950

Injection Leuprolide Acetate (For Depot Suspension) Per 3.75 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.00 / $3,460.64 / $5,190.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $2,131.57 / $8,557.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,455.16 / $5,943.65 / $9,520.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.58 / $1,616.85 / $11,006.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $1,730.32 / $1,730.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$683.48 / $2,101.89 / $2,732.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.10 / $1,737.10 / $1,916.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,737.10