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Arkansas rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $28.84 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $19.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $20.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $21.88 / $21.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $8.71 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $15.85 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $15.14 / $19.05
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $15.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $9.12 / $22.39