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Arizona rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $2.00 / $4.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.56 / $5.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $4.26 / $7.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.09 / $9.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.48 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.58