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Ohio rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $97.82 / $510.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.58 / $181.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.83 / $7.53 / $20.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $5.42
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.30 / $4.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.95 / $5.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.95 / $4.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $13.35
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.77 / $9.14 / $25.98
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $13.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $4.50 / $5.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.47 / $4.69