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New York 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 / $2.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.42 / $1.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.92
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $2.00 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.79
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.47
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.47
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.61
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.47 / $1.47
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.47