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Vermont rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $1.61 / $1.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.34 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.34 / $2.22
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.51 / $2.18