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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
$3.02 / $7.76 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $22.91 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $4.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $6.61 / $10.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $4.47 / $4.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.80 / $4.37
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24