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Rhode Island 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
$76.73 / $76.73 / $76.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $24.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.29 / $24.29 / $36.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $36.04