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Arkansas rates for HCPCS J1955

Injection Levocarnitine Per 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.93 / $28.33 / $29.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $28.33 / $29.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.36 / $26.36 / $26.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.30 / $26.36 / $26.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.87 / $23.61 / $23.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $39.29