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Maine rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.29 / $3.29 / $3.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.36 / $1.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.72 / $4.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.29 / $3.29 / $3.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.36 / $3.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.49