go back

South Dakota rates for HCPCS J1953

Injection, levetiracetam, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $72.89 / $402.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.10 / $0.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05