go back

Alaska rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $60.21 / $680.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.57 / $7.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.57 / $8.57 / $8.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $10.37
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.29 / $16.80 / $26.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.69 / $16.80 / $39.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.83 / $9.66