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Missouri 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
$1,737.10 / $2,269.40 / $9,856.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,866.11 / $13,257.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $2,941.54 / $6,215.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $2,162.90
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,692.61 / $1,946.50 / $8,351.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,572.08 / $1,737.10 / $2,067.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,670.30 / $1,670.30 / $1,670.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $2,154.50