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Louisiana 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 / $1,823.95 / $6,079.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $1,747.63 / $2,101.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.34 / $181.10 / $1,739.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,739.87 / $1,739.87 / $1,774.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $2,056.57 / $2,056.57
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,678.41 / $1,730.32 / $2,214.81