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Illinois 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
$24.29 / $41.32 / $63.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.29 / $29.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $37.50 / $423.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.07 / $35.42 / $122.70
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.69 / $30.69 / $30.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $25.88