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Maryland rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $80.45 / $259.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $8.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.41 / $4.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.16 / $4.16 / $4.16