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Virginia rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.49 / $2.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.49 / $1.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $3.00 / $4.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.64 / $3.98
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.70 / $2.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.27
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.72 / $2.52
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.72 / $2.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.51 / $2.61