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Utah rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.78 / $2.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $3.38 / $4.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.42 / $1.58