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Massachusetts rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.57 / $2.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.42 / $1.48
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $3.81 / $85.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $1.81 / $3.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $83.43 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.04
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.22