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Oklahoma rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $96.68 / $675.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.48 / $3.48 / $3.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $4.55 / $7.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $3.22 / $3.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $4.47 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.36 / $3.95 / $4.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.41 / $4.47