go back

Illinois rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $80.19 / $471.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.57 / $130.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.41 / $19.95 / $66.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.75 / $6.75 / $6.75
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $5.57 / $47.32
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.19 / $4.19 / $4.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.42 / $5.57