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Montana rates for HCPCS J1953

Injection, levetiracetam, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.25 / $50.40 / $380.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04