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South Carolina 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
$1,816.83 / $3,853.90 / $5,492.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,480.89 / $1,747.63 / $2,361.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.63 / $948.69 / $1,791.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.77 / $1,499.86 / $2,082.27
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.39 / $1,816.84 / $4,108.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.52 / $2,390.52 / $2,390.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,834.14 / $1,926.21