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New Hampshire rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.25 / $2.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.42 / $1.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $2.56 / $6.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $1.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $2.31 / $4.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.51