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Alaska rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.11 / $0.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.19
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.56 / $0.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.56 / $1.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.09 / $0.18