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Pennsylvania rates for HCPCS J1955

Injection, levocarnitine, per 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.61 / $56.84 / $325.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.84 / $54.55
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.77 / $25.61 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.50 / $24.50 / $24.50
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.13 / $202.86 / $271.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.53 / $56.84 / $73.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.53 / $73.84
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.27 / $23.61 / $23.61
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.22 / $30.22 / $35.07
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.22 / $30.22 / $35.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $37.03