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Wisconsin rates for HCPCS J1951

Injection, leuprolide acetate for depot suspension (Fensolvi), 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.63 / $273.83 / $322.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.99 / $145.22 / $241.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.24 / $260.83 / $314.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.99 / $140.99 / $179.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.03 / $193.03 / $225.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.99 / $341.41 / $488.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.90 / $205.58 / $233.61
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.43 / $140.43 / $310.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.65 / $281.98 / $281.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.43 / $140.43 / $309.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.43 / $156.33 / $281.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $134.26
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.43 / $140.43 / $310.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.65 / $281.98 / $281.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.99 / $208.10 / $456.01
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.99 / $140.99 / $671.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.99 / $140.99 / $140.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.95 / $197.95 / $197.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.99 / $156.94 / $197.39