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Illinois rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $2.24 / $2.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $1.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $6.72 / $33.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $2.66 / $6.95
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.50 / $2.22