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Washington rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.54 / $93.74 / $521.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.05 / $182.61
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $6.28 / $164.71
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.51 / $9.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $7.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.95
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $4.19 / $8.22
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.28 / $9.96 / $9.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.79 / $12.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.03