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Washington, DC 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
$1,088.94 / $4,031.64 / $18,607.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $2,605.65 / $4,405.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $1,632.38 / $1,730.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,470.77 / $1,470.77 / $1,730.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.02 / $1,955.26 / $2,547.07