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Hawaii rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.03 / $8.03 / $104.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $58.87 / $291.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.03 / $8.03 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.22
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.07 / $6.07 / $6.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $3.86 / $4.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.83 / $4.99
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.52 / $3.95 / $5.41