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Alaska rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $2.06 / $7.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $2.64 / $5.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $3.78 / $3.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $4.57
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $3.72 / $5.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.56 / $3.78 / $8.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $2.13 / $4.26