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Utah rates for HCPCS J9219

Leuprolide Acetate Implant 65 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,000.45 / $4,000.45 / $4,000.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $4,000.45 / $4,145.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $5,684.00 / $5,684.00