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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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.78 / $2.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.75 / $3.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.35 / $1.35
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.41 / $1.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.58