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Tennessee rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.42 / $2.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.42 / $1.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.42 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.22