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Wyoming rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.66 / $2.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.58