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New Hampshire 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
$1,730.31 / $2,084.52 / $4,555.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.31 / $1,730.32 / $1,730.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.37 / $3,114.58 / $7,849.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,737.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $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
$1,815.45 / $2,810.04 / $5,340.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,834.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.04 / $699.68 / $1,056.71