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Michigan rates for HCPCS J0640

Injection, leucovorin calcium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $77.73 / $236.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.31 / $130.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $7.15 / $13.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.12 / $1.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.90 / $5.90 / $5.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $3.22 / $3.22
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $72.06 / $298.05
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.31 / $7.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $4.03 / $4.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.47 / $5.14