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New Hampshire rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $7.90 / $380.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.85 / $4.83 / $13.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.22 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $5.36 / $9.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.47 / $2.39