go back

South Dakota rates for HCPCS J0641

Levoleucovorin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $2.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $2.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.32 / $0.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.31 / $2.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.07
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04