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Massachusetts 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
$23.61 / $23.61 / $47.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.55 / $29.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.88 / $63.27 / $260.70
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $37.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.33 / $30.13 / $64.22
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.10 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $49.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $260.70
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $37.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $37.03