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Pennsylvania rates for HCPCS J1953

Injection, levetiracetam, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $27.00 / $195.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.31
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.08 / $2,166.40
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
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 / $0.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $1.37 / $5.23
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.08 / $2,166.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $22.05 / $225.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.15
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.93 / $1,672.79 / $2,081.04
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.07