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Pennsylvania rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $96.34 / $647.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $58.69 / $205.20
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $5.03 / $1,494.82
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.97 / $3.49 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $3.34 / $3.34
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.33 / $17.93 / $52.36
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $4.88 / $1,435.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $96.34 / $885.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $28.39 / $137.97
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.38 / $2,097.73 / $3,101.27
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.22 / $3.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $4.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $4.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.45 / $5.89