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Rhode Island 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
$4,287.87 / $4,292.34 / $5,623.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,747.63 / $1,799.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.10 / $1,737.10 / $1,837.13
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
$1,632.38 / $1,730.32 / $1,730.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.24 / $1,730.32 / $1,926.21