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New Hampshire rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $35.48 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.80 / $7.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $7.94 / $14.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $4.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.80 / $3.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.03 / $6.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $4.07