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South Carolina rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $190.55 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $34.67
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.80 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $3.09 / $5.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.80 / $8.13
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $5.37 / $11.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $3.89 / $4.57