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New Hampshire 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 / $27.20 / $48.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $24.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.23 / $35.42 / $97.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $24.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.27 / $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
$24.77 / $38.34 / $72.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.52 / $23.61 / $34.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.72 / $38.20 / $48.62