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Texas rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.46 / $2.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.44 / $1.57
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $2.02 / $2.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.42 / $2.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.42 / $2.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.42 / $2.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.58 / $1.58
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.35 / $1.92