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Utah 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
$2,007.18 / $5,838.51 / $39,984.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,007.18 / $2,007.18 / $8,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.81 / $2,287.86 / $2,531.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,443.94 / $3,381.34 / $4,854.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,926.21