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Arizona rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.12 / $0.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $167.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.10 / $0.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.06 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06