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Maine rates for HCPCS J1955

Injection, levocarnitine, per 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.78 / $54.78 / $59.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $29.39 / $29.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.00 / $73.00 / $73.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $28.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.78 / $54.78 / $59.03
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.83 / $29.39 / $59.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $41.32