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Utah rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.05 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06