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Arizona rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.37 / $80.27 / $244.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $58.69 / $212.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.06 / $11.66 / $19.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $3.82 / $20.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $10.99 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $3.95 / $4.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.80