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Maine rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.47 / $81.78 / $241.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.35 / $4.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.96 / $9.96 / $9.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
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
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.60 / $9.60 / $9.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.47 / $80.95 / $436.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.35 / $6.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $5.64