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Montana rates for HCPCS J1950

Injection, leuprolide acetate (for depot suspension), per 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,925.18 / $3,925.18 / $3,925.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.63 / $1,747.63 / $32,380.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.66 / $1,906.66 / $3,677.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,906.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,906.66 / $1,906.66 / $3,677.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,877.24 / $2,448.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32