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Washington rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.08 / $1.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $2.14
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.34
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.07
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.37
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.19
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.16
Regence BlueShield
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