go back

Hawaii rates for HCPCS J1950

Injection, leuprolide acetate (for depot suspension), per 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,955.10 / $2,955.10 / $2,955.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $2,056.78 / $6,394.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,955.10 / $2,955.10 / $2,955.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,433.50 / $2,433.50 / $2,433.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,903.36 / $2,076.39 / $2,422.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.21 / $2,000.13 / $2,595.48
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.93 / $1,617.65 / $2,016.80