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Tennessee rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $44.32 / $330.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $164.71 / $164.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.41 / $6.57