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Ohio rates for HCPCS J1953

Injection, levetiracetam, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $31.62 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.08
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.10
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.13 / $0.65
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.05
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05