go back

Michigan rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.46 / $3.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.42 / $1.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.81 / $3.23 / $5.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.44 / $1.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.13 / $3.23
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.42 / $1.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.35 / $1.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.58 / $1.82