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Nebraska rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $1 · 10th–90th $1$30%20%40%10th90th$1Professionalmedian $1 · 10th–90th $1$40%20%10th90th$1$1.0$2.0$5.0$10.0$20.0$50.0

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
$1.41 / $2.19 / $2.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.41 / $4.27
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.15 / $1.41 / $1.51
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.62 / $1.66 / $1.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.19 / $2.19 / $2.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.45 / $1.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.51 / $3.47 / $85.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.17 / $1.41
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $1.41
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.17 / $1.45 / $3.16
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.41 / $2.14