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South Carolina rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.49 / $4.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.56 / $1.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $2.66 / $4.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.35 / $2.90
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.79 / $3.51
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.20 / $3.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $1.58