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Vermont rates for HCPCS J1955

Injection Levocarnitine Per 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $41.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.72 / $26.72 / $26.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.27 / $27.60 / $45.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.27 / $27.60 / $45.99
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.43 / $23.61 / $37.03