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Washington rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.82 / $2.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.42 / $1.56
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $2.54 / $5.27
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.46 / $2.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.35 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.74
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.56 / $3.36
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $2.21 / $3.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.46 / $2.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.04 / $3.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.82