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Every billing code / Treatments and drugs / Injections and Infusions (nononcologic)

HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Current codeInjection - Monoclonal Antibodies39 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.

HospitalMedicare Advantage rates (lowest – highest)Cash priceList price (before discounts)
Cascade Valley HospitalArlington$531 – $9,3861 plan$38.51 – $348$48.14 – $435
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$3.88 – $50.50$9.68 – $126
EvergreenHealth Medical CenterKirkland—$76.80 – $138$96.00 – $172
Harborview Medical CenterSeattleFile dated 2026-04-01———
Highline Medical CenterBurienFile dated 2026-02-28—$10.26 – $478$33.60 – $1,567
Island HospitalAnacortes———
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$152 – $156$218 – $223
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01———
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$38.66 – $48.02$96.65 – $120
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$31.52$78.80
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$31.40 – $33.50$78.50 – $83.75
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01—$2.08 – $83.18$4.15 – $166
PeaceHealth Peace Island Medical CenterFriday Harbor—$159 – $355$245 – $546
PeaceHealth Southwest Medical CenteVancouver—$159 – $355$245 – $546
PeaceHealth St John Medical CenterLongview—$25.55 – $355$39.30 – $546
PeaceHealth St Joseph Medical CenterBellingham—$159 – $389$245 – $598
PeaceHealth United General Medical CenterSedro Woolley—$159 – $522$245 – $803
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$101 – $532$144 – $759
Providence Centralia HospitalCentraliaFile dated 2026-04-01———
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$101 – $532$144 – $759
Providence Regional Medical Center EverettEverettFile dated 2026-04-01———
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$92.32 – $138$132 – $197
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$18.56 – $24.69$35.70 – $47.49
Seattle Children's HospitalSeattle—$180$180
Skagit Valley HospitalMount Vernon—$38.51 – $348$48.14 – $435
St Anthony HospitalGig HarborFile dated 2026-02-28—$10.22 – $477$33.60 – $1,567
St Clare HospitalLakewoodFile dated 2026-02-28—$9.69 – $452$33.60 – $1,567
St Elizabeth HospitalEnumclawFile dated 2026-02-28$6.05 – $34512 plans$11.88 – $554$33.60 – $1,567
St Francis Community HospitalFederal WayFile dated 2026-02-28—$10.55 – $492$33.60 – $1,567
St Joseph Medical CenterTacomaFile dated 2026-02-28—$11.13 – $519$33.60 – $1,567
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$14.83 – $691$33.60 – $1,567
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$164$341
Swedish IssaquahIssaquahFile dated 2026-04-01—$164$341
Swedish Medical CenterSeattleFile dated 2026-04-01—$164$341
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$164$341
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$3.49 – $34.42$8.71 – $86.05
University of Washington Medical CtrSeattleFile dated 2026-04-01———
Virginia Mason Medical CenterSeattle—$4.20 – $15.43$8.24 – $30.25
Yakima Valley MemorialYakimaFile dated 2026-08-27—$6.64 – $35.12$16.60 – $87.80

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.