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Virginia rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.38 / $91.96 / $552.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.38 / $5.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.06 / $6.90 / $10.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $3.86 / $9.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $5.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.06 / $3.90 / $9.11
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.90 / $9.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.41 / $4.49