Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Levoleucovorin 50MG IFC (FUSIL)Rnd 0.5mg
Low
$0
Average
$298
Median
$70
High
$1.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 251.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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17 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $3.7k | $3.7k | $656 | 18% | — | $3.1k – $4.4k |
| 2 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 3 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $78 | $72 | $48 | 67% | — | $11 – $159 |
| 4 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $76 | $70 | $47 | 67% | — | $11 – $154 |
| 5 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $76 | $70 | $47 | 67% | — | $11 – $154 |
| 6 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $96 | $88 | $59 | 67% | — | $14 – $195 |
| 7 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $861 | $861 | — | — | — | $861 – $861 |
| 8 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $766 | $766 | — | — | — | $766 – $766 |
| 9 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $766 | $766 | — | — | — | $766 – $766 |
| 10 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 11 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 12 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $6 | $6 | $4 | 68% | — | $2 – $11 |
| 13 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $6 | $6 | $4 | 68% | — | $2 – $11 |
| 14 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $6 | $6 | $4 | 68% | — | $2 – $11 |
| 15 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $6 | $6 | $4 | 68% | — | $2 – $11 |
| 16 | Northside Hospital, Inc. Canton, GA fee schedule · outpatient | 1 | $6 | $6 | $4 | 68% | — | $2 – $11 |
| 17 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $180 | $180 | — | — | — | $180 – $180 |
← Payers reporting HCPCS J0641 · Snapshot 20261111T120946Z-9134e7f7