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Georgia rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.42 / $5.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $1.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.31 / $5.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.78
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
$1.49 / $7.00 / $12.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $1.82