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Georgia 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
$1,730.32 / $6,626.17 / $24,754.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,747.63 / $2,345.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $2,816.96 / $6,350.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,384.25 / $1,730.32 / $1,730.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $3,391.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $1,632.38 / $1,730.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.44 / $783.44 / $1,833.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,770.52 / $4,593.33 / $4,593.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,834.14 / $2,154.50