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Ohio rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.63 / $3.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $3.02 / $9.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.58 / $2.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.55
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.41
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.78 / $2.04
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $2.19 / $3.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.58 / $1.74