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Vermont 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
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,922.39 / $2,984.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,942.53 / $1,942.53 / $1,958.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $1,890.90 / $3,151.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.38 / $1,890.90 / $3,151.50
MVP Health Care
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
$1,643.80 / $1,831.33 / $1,926.21