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Hawaii rates for HCPCS J0642

Injection Levoleucovorin (Khapzory) 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.97 / $1.97 / $1.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.71 / $1.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.62 / $2.13
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.74 / $2.41