go back

Utah rates for HCPCS J9217

Leuprolide acetate (for depot suspension), 7.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.68 / $418.57 / $2,123.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $281.79 / $2,312.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.49 / $245.92 / $274.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $210.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.60 / $194.27 / $286.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.58 / $364.69 / $523.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.10 / $239.16 / $251.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.45 / $176.45 / $176.45