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Wyoming rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $3.95 / $3.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $9.60 / $9.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $4.47