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Texas rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.25 / $62.58 / $198.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.25 / $5.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $5.94 / $12.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.57
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.59 / $8.89 / $558.60
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.70 / $60.70 / $60.70
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $164.71 / $164.71
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $4.59 / $34.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.96 / $3.22 / $7.53
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,090.20 / $1,468.98 / $8,773.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.22 / $4.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.22 / $5.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $5.79 / $5.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.47 / $4.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.16 / $4.34