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Tennessee 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
$1,201.75 / $1,737.10 / $9,450.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,922.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.41 / $2,058.41 / $2,058.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,221.81 / $8,351.50 / $8,651.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,670.30 / $1,670.30 / $2,037.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,834.14 / $2,214.81