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Illinois 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 / $2,739.65 / $8,969.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $1,737.10 / $4,487.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $1,874.92 / $17,565.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.07 / $1,730.32 / $2,422.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,249.42 / $2,249.42 / $2,249.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,829.90 / $2,202.69