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North Carolina rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $2.25 / $3.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.56 / $2.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $2.00 / $2.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $1.19 / $1.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.66
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $1.69 / $2.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
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 / $1.51 / $1.87
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00