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Texas rates for HCPCS J0641

Levoleucovorin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.07 / $0.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.73 / $1.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.88 / $152.88 / $152.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $1.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.07 / $0.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.07 / $0.07
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.08