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Oklahoma rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.21 / $1.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.27 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.18 / $1.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.58