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Pennsylvania rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $2.62 / $14.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.44 / $5.24
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.54 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.47 / $1.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.91 / $3.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.44 / $3.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.42 / $1.42
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.48 / $1.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.48 / $1.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.22