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Idaho rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $421.87 / $1,028.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.57 / $130.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.22
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
$3.29 / $4.26 / $49.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $3.86 / $4.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $5.15