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Illinois rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.75 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.17 / $2.69 / $8.71
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $1.62 / $5.89
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06