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Nebraska rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $6.43 / $245.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.52 / $90.32 / $125.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $8.65 / $9.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $18.21 / $22.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.56 / $4.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.02 / $10.01 / $164.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $3.95 / $5.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.87 / $4.22 / $6.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $4.74 / $7.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.47