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Georgia rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.75 / $2.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.21 / $0.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $1.70 / $1.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.07