go back

Rhode Island rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $4.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $2.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $1.58