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Maryland 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 / $2.63 / $2.75
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.06 / $0.06
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04