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Maryland rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.42 / $1.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.58 / $1.73
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35