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Maine rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $4 · 10th–90th $3$40%50%10th$4Professionalmedian $1 · 10th–90th $1$20%50%90th$1$1.0$2.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.24 / $3.55 / $3.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.26 / $1.58 / $3.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.82 / $3.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.55
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.41 / $2.04