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Nebraska rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.42 / $3.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $5.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.46 / $1.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.64 / $1.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $2.18 / $2.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.42 / $1.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $3.43 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.18 / $1.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.93 / $2.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.78 / $4.88
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 / $1.42 / $1.69