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New Mexico rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.75 / $1.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.80 / $5.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $7.45 / $12.18
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 / $1.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.42 / $1.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42