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Ohio rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $87.10 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $6.03 / $8.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.11 / $0.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
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 / $0.55
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.08
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.07