go back

Oregon rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.38 / $2.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.42 / $5.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $2.29 / $2.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $2.14 / $3.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.02 / $3.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $1.85
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.61 / $3.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $2.12 / $3.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.54 / $1.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $2.47 / $5.42
Regence BlueShield
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 / $1.58