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South Dakota rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $138.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.25 / $4.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.56 / $3.56 / $4.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.99 / $6.68 / $10.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.05 / $4.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.45 / $4.74 / $6.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.45 / $4.74 / $6.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $3.53 / $15.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.47
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $3.95 / $3.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $3.95 / $3.95