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Ohio rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.25 / $35.72 / $100.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $9.65 / $13.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.63 / $9.21 / $20.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $14.58 / $23.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.54 / $6.54 / $18.09
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.35 / $8.35 / $8.35
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.60 / $10.60 / $10.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.94 / $13.91 / $17.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.61 / $13.29 / $21.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.61 / $13.64 / $50.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $8.61 / $19.30
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.61 / $25.07 / $88.76
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $8.48 / $25.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.94 / $10.93 / $15.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $7.95 / $21.37