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Wisconsin rates for HCPCS J0641

Levoleucovorin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $167.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.30 / $0.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.11 / $0.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $1.38
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $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
$0.02 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $1.38
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.12 / $0.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.07 / $0.09