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Missouri rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $2.66 / $2.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.45 / $2.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.41 / $5.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $2.92 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.18 / $1.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.43 / $2.17