go back

Indiana rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $3.31 / $5.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.44 / $1.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.84 / $3.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.42 / $2.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.78
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 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.58 / $2.61