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Michigan rates for HCPCS J1595

Injection, glatiramer acetate, 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $60.00 / $187.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $1,959.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $166.95 / $216.41
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $68.90 / $82.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $66.31