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Maine 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
$1,799.53 / $4,325.80 / $7,461.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $1,799.54 / $2,101.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.43 / $2,101.82 / $5,483.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $2,095.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,474.07 / $4,325.80 / $11,301.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $1,799.54 / $3,509.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,470.77 / $1,730.32 / $2,508.96