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Montana rates for HCPCS J0641

Levoleucovorin Injection

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.12 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.06 / $0.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06