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Illinois rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.23 / $107.06 / $193.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $9.65 / $14.67
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.63 / $6.63 / $17.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.14 / $70.68 / $175.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $9.41 / $10.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.85 / $32.47 / $61.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.66 / $15.43 / $20.14
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.52 / $23.19 / $110.85
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $17.23 / $17.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.63 / $9.09 / $16.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $9.93 / $18.09