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Montana rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.29 / $644.51 / $875.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $3.57 / $158.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $9.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $9.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.50 / $4.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22