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California rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.31 / $5.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.42 / $5.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $2.27 / $5.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $3.23
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.66 / $4.05
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $4.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.70 / $3.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.42 / $1.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.07
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $3.55 / $3.55
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.56 / $2.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $3.24