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Minnesota 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 / $1,730.32 / $7,779.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,868.75 / $32,380.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,371.91 / $1,617.65 / $3,996.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.68 / $1,721.06 / $1,737.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,094.61 / $2,660.43 / $5,249.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.84 / $1,933.84 / $2,161.32
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,976.05 / $4,133.59 / $6,012.50
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,701.83 / $1,701.83 / $2,314.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.69 / $2,565.90 / $3,575.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.10 / $1,933.76 / $3,323.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,926.21 / $3,736.28