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Wisconsin rates for HCPCS J0640

Leucovorin Calcium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $167.36 / $788.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $58.69 / $218.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.03 / $4.03 / $4.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.76 / $5.90 / $5.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $5.47 / $11.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.56 / $6.97 / $7.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $3.95 / $7.14
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $6.44 / $6.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $17.93 / $23.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $4.47 / $6.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $3.95 / $7.14
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $6.44 / $6.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.99 / $13.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $164.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $4.51 / $5.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.83 / $4.83