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Pennsylvania rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.75 / $2.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.82 / $295.12
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.05 / $5,011.87
Capital Blue Cross
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 / $0.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.82 / $295.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.20 / $0.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.09