go back

New York 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 / $169.82 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $1.74
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.10
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.08
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.07
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $1.78