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Utah rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.73 / $307.00 / $442.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.73 / $3.73 / $3.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.87 / $5.50 / $6.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.22 / $4.47