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Nebraska 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 / $37.45 / $52.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.29 / $54.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $25.39 / $26.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.39 / $26.46 / $27.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.83 / $31.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.45 / $79.12 / $260.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $24.29 / $26.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.41 / $29.25 / $36.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $29.25 / $50.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.43 / $23.61 / $35.42