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Massachusetts 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 / $4,292.34 / $8,800.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,799.54 / $3,707.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.10 / $1,477.55 / $5,644.30
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,831.33 / $2,188.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,856.63 / $2,207.89 / $4,706.47
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $2,609.98 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $3,593.53
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,024.10 / $2,925.28 / $32,010.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,301.66 / $2,301.66 / $8,651.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,834.14 / $2,595.48
Tufts
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.04 / $1,718.39 / $2,346.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,834.14 / $2,595.48