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North Dakota rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.51 / $1.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.48 / $2.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.26 / $1.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.58 / $1.78