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Wisconsin rates for HCPCS J0641

Injection, levoleucovorin, not otherwise specified, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $169.82 / $295.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.30 / $0.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $1.38
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.12 / $0.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $1.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.08