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Utah rates for HCPCS J0641

Levoleucovorin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.07 / $0.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.05 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.07